Provider Demographics
NPI:1154613750
Name:WALKER, SPENCER WALLACE (DDS)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:WALLACE
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6552
Mailing Address - Country:US
Mailing Address - Phone:319-277-7441
Mailing Address - Fax:
Practice Address - Street 1:907 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6552
Practice Address - Country:US
Practice Address - Phone:319-277-7441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice