Provider Demographics
NPI:1154380277
Name:WALKER, FRANK ALAN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ALAN
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:F.
Other - Middle Name:ALAN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2110 S PETRA AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8542
Mailing Address - Country:US
Mailing Address - Phone:208-323-9524
Mailing Address - Fax:
Practice Address - Street 1:10233 W OVERLAND RD.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709
Practice Address - Country:US
Practice Address - Phone:208-323-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-34231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice