Provider Demographics
NPI:1699802280
Name:WALERKO, FRANK MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:MICHAEL
Last Name:WALERKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 LUTE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5008
Mailing Address - Country:US
Mailing Address - Phone:219-762-3842
Mailing Address - Fax:219-764-7406
Practice Address - Street 1:6060 LUTE RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5008
Practice Address - Country:US
Practice Address - Phone:219-762-3842
Practice Address - Fax:219-764-7406
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN81581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice