Provider Demographics
NPI:1538170725
Name:WALKER, WM G (DDS)
Entity type:Individual
Prefix:DR
First Name:WM
Middle Name:G
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:GLICK
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:755 BROAD ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-2248
Mailing Address - Country:US
Mailing Address - Phone:423-479-4169
Mailing Address - Fax:423-479-4503
Practice Address - Street 1:755 BROAD ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-2248
Practice Address - Country:US
Practice Address - Phone:423-479-4169
Practice Address - Fax:423-479-4503
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0032671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice