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General NPI Number Information
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NPI Number | 1417765991
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Entity Type | Organization
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Legal Business Name | MICHAELA M WALKER DDS, LLC
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 470 HIGHLAND AVE STE 1AND2
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City | COOS BAY
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State | OR
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Zip | 97420-2243
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Country | US
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Telephone | 541-267-6425
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Fax | 541-267-4203
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Provider Business Mailing Address
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Address Line | 470 HIGHLAND AVE STE 1AND2
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City | COOS BAY
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State | OR
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Zip | 97420-2243
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Country | US
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Telephone | 541-267-6425
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Fax | 541-267-4203
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAELA WALKER
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Credential | DDS
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Telephone | 707-499-8537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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