1730296054 NPI number — DR. TABREENA V M WALKER DDS

Table of content: DR. TABREENA V M WALKER DDS (NPI 1730296054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730296054 NPI number — DR. TABREENA V M WALKER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
TABREENA
Provider Middle Name:
V M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730296054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
761ST TANK BATTALION
Provider Second Line Business Mailing Address:
BLDG 330
Provider Business Mailing Address City Name:
FORT HOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76544-2079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-285-2014
Provider Business Mailing Address Fax Number:
254-285-2182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
761ST TANK BATTALION
Provider Second Line Business Practice Location Address:
BLDG 330
Provider Business Practice Location Address City Name:
FORT HOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76544-2079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-285-2014
Provider Business Practice Location Address Fax Number:
254-285-2182
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  20578 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TPI 284661001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: B20578-01 . This is a "TEXAS CHIP DENTAL SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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