Provider Demographics
NPI:1801473178
Name:WALKER, DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 S THE STRAND UNIT 203
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3839
Mailing Address - Country:US
Mailing Address - Phone:661-477-0528
Mailing Address - Fax:
Practice Address - Street 1:7212 REGIONAL ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2326
Practice Address - Country:US
Practice Address - Phone:925-462-1755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107991122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program