MEDICARE: LESLIE F WALKER D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	5658087-9922	UT

General Provider Information

NPI Number	:	1578764437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE F WALKER D.M.D.

Provider Business Mailing Address
First Line	:	4252 HIGHLAND DR
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2670
Country	:	US
Telephone Number	:	801-278-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	4252 HIGHLAND DR
Second Line	:	SUITE 100
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-2670
Country	:	US
Telephone Number	:	801-278-3636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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