Basic Information
| Provider Information | |||||||||
| NPI: | 1497157507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | CLINT | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 S RASPBERRY LN | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928082269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312245076 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5731 E SANTA ANA CANYON RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928073234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149982956 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2014 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 63663 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.