MEDICARE: MS. JOAN ROULSTON WALKER DDS

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	122300000X	Dentist	DO15528	MO

General Provider Information

NPI Number	:	1851303572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN ROULSTON WALKER DDS

Provider Business Mailing Address
First Line	:	4025 NE LAKEWOOD WAY
Second Line	:	SUITE 200
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064
Country	:	US
Telephone Number	:	816-795-5626
Fax Number	:	816-795-5629

Provider Business Practice Location Address
First Line	:	4025 NE LAKEWOOD WAY
Second Line	:	SUITE 200
City	:	LEES SUMMIT
State	:	MO
Zip	:	64064
Country	:	US
Telephone Number	:	816-795-5626
Fax Number	:	816-795-5629

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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