Individual provider Active NPI

Douglas Donald Walker, D.D.S.

  • Dentist
  • Charleston, SC
National Provider Identifier
1356605190
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8129 Issued in SC
Practice address
776 Ellis Oaks Drive
Suite 3a
Charleston, SC 29412-7903
Phone
(843) 761-7380
Fax
(843) 761-7385
NPI assigned
Jun 26, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30-023768 OH
Dentist 122300000X 8129 SC Primary

Addresses

Primary practice location

776 Ellis Oaks Drive
Suite 3a
Charleston, SC 29412-7903

Mailing address

3751 S Live Oak Dr
Suite G
Moncks Corner, SC 29461-7903
Phone (843) 761-7380

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160623001258 SC Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5395036255

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30-023768OHMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
DW by DW, PC Dentist CurrentSince Sep 3, 2025 Accepting new patients
Carnes Crossroads Dental P.a Dentist Past Accepting new patients
Carnes Crossroads Dental Arts P.a. Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1356605190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3751 S LIVE OAK DR",
            "address_2": "SUITE G",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294617903",
            "telephone_number": "843-761-7380",
            "fax_number": "843-761-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "776 ELLIS OAKS DRIVE",
            "address_2": "SUITE 3A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294127903",
            "telephone_number": "843-761-7380",
            "fax_number": "843-761-7385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "DOUGLAS",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-26",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-023768",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "8129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.