MEDICARE: MICHAELA M WALKER DDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1417765991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAELA M WALKER DDS, LLC

Provider Business Mailing Address
First Line	:	470 HIGHLAND AVE STE 1AND2
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2243
Country	:	US
Telephone Number	:	541-267-6425
Fax Number	:	541-267-4203

Provider Business Practice Location Address
First Line	:	470 HIGHLAND AVE STE 1AND2
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2243
Country	:	US
Telephone Number	:	541-267-6425
Fax Number	:	541-267-4203

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAELA WALKER
Credential	:	DDS
Telephone Number	:	707-499-8537

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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