Clint Walker Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

CLINT WALKER DENTAL CORPORATION

Doing business as

17th Street Modern Dentistry Dental Group

Practice address

270 E 17TH St Ste 15
Costa Mesa, CA 92627-3845

Phone

(714) 224-0480

Fax

(714) 224-0480

NPI assigned

Apr 24, 2018

Last updated

May 11, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Clint Walker, DDS

Title

Owner

Phone

(714) 224-0480

Specialties & licenses 1

Addresses

Other names 1

• 17th Street Modern Dentistry Dental Group Doing business as

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gabrielle Jannotta

  • Dentist
  • Costa Mesa, CA
  • NPI 1174176515
  NPD (past)
• Jong Min Kong, DMD

  • Dentist
  • Costa Mesa, CA
  • NPI 1912631235
  NPD (past)
• Antonela Kroqi

  • General Practice Dentistry
  • Costa Mesa, CA
  • NPI 1962240879
  NPD (past)
• Omar Alkorek, DMD

  • Dentist
  • Leesburg, FL
  • NPI 1841720075
  NPD (past)

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

{
    "created_epoch": "1524528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1790273829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 E 17TH ST STE 15",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273845",
            "telephone_number": "714-224-0480",
            "fax_number": "714-224-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINT WALKER DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-24",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-224-0480",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "17th Street Modern Dentistry Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathliyah Ellen Clement
• Stephanie Clements
• Joey Lynn Clevenger
• Erika Angeline Clever, LMFT
• Demaris Climax
• Rachel Renee Cliser, NP
• Cloudberry Nutrition LLC
• Club DME
• Coalition Physical Therapy
• Coast Medical Equipment, Inc

• Dentist in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.