Provider Demographics
NPI:1588722532
Name:WALKER, VERONICA SIAFACAS (DDS)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:SIAFACAS
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-2534
Mailing Address - Country:US
Mailing Address - Phone:336-993-3727
Mailing Address - Fax:336-993-3918
Practice Address - Street 1:428 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2534
Practice Address - Country:US
Practice Address - Phone:336-993-3727
Practice Address - Fax:336-993-3918
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97792OtherBCBSNC
NC8997792Medicaid
NC97792OtherBCBSNC