Healthcare Provider Details

I. General information

NPI: 1043281009
Provider Name (Legal Business Name): CAMILLE E WALKER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N PINE ST
ELLENSBURG WA
98926-3330
US

IV. Provider business mailing address

109 N PINE ST
ELLENSBURG WA
98926-3330
US

V. Phone/Fax

Practice location:
  • Phone: 509-962-6902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE00010300
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD9408
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: