Provider Demographics
NPI:1134464530
Name:WALKER, WENDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 GRIFFIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2379
Mailing Address - Country:US
Mailing Address - Phone:360-825-1661
Mailing Address - Fax:360-825-4712
Practice Address - Street 1:2949 GRIFFIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2379
Practice Address - Country:US
Practice Address - Phone:360-825-1661
Practice Address - Fax:360-825-4712
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000063981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice