Walter F. Tickner, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

23418 Issued in CA

Practice address

1736 E 14TH St
San Leandro, CA 94577-4803

Phone

(510) 351-1400

Fax

(510) 351-3116

NPI assigned

Aug 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Walter F. Tickner, DDS, Inc.

  • Dental Clinic/Center
  • San Leandro, CA
  • NPI 1073627345
  NPD (past) Authorized official

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1962516211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1736 E 14TH ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774803",
            "telephone_number": "510-351-1400",
            "fax_number": "510-351-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1736 E 14TH ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945774803",
            "telephone_number": "510-351-1400",
            "fax_number": "510-351-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKNER",
        "first_name": "WALTER",
        "middle_name": "F.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "23418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary K Tia
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• Melissa Tice
• Mirian Guadalupe Ticoulet
• Christina Tiedeman
• Mary Tieh
• Breanna Rose Tillman
• Tamarah Elizabeth Tilos, B.A.

• Dentist in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.