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General NPI Number Information
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NPI Number | 1639261209
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Entity Type | Individual
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Provider Name | MICHAEL STEPHEN WALKER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2007 MEMORIAL AVE
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City | WASHINGTON
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State | IN
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Zip | 47501-3127
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Country | US
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Telephone | 812-257-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 4317 S RIDGE LN
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City | WASHINGTON
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State | IN
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Zip | 47501-7493
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Country | US
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Telephone | 812-257-1222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010078A
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License Number State | IN
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