Provider Demographics
NPI:1306049622
Name:SWANEY, WALKER JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:WALKER
Middle Name:JAMES
Last Name:SWANEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:WALKER
Other - Middle Name:JAMES
Other - Last Name:SWANEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2155 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5223
Mailing Address - Country:US
Mailing Address - Phone:662-234-5222
Mailing Address - Fax:662-234-5254
Practice Address - Street 1:2155 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5223
Practice Address - Country:US
Practice Address - Phone:662-234-5222
Practice Address - Fax:662-234-5254
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS170075122300000X
MS2825941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0064235Medicaid
MS0064235Medicaid