Provider Demographics
NPI:1417765991
Name:MICHAELA M WALKER DDS, LLC
Entity type:Organization
Organization Name:MICHAELA M WALKER DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-499-8537
Mailing Address - Street 1:470 HIGHLAND AVE STE 1AND2
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2243
Mailing Address - Country:US
Mailing Address - Phone:541-267-6425
Mailing Address - Fax:541-267-4203
Practice Address - Street 1:470 HIGHLAND AVE STE 1AND2
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2243
Practice Address - Country:US
Practice Address - Phone:541-267-6425
Practice Address - Fax:541-267-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental