MEDICARE: DR. MICHAELA WALKER DDS

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	1223G0001X	General Practice Dentistry	11184	OR

General Provider Information

NPI Number	:	1457894610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAELA WALKER DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	07/30/2025

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