Provider Demographics
NPI:1770703191
Name:WALKER, JOHN H (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:WALKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462
Mailing Address - Country:US
Mailing Address - Phone:978-345-7988
Mailing Address - Fax:978-345-1191
Practice Address - Street 1:119 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462
Practice Address - Country:US
Practice Address - Phone:978-345-7988
Practice Address - Fax:978-345-1191
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9758313Medicaid
MAX04572OtherBCBS