Provider Demographics
NPI:1275674228
Name:DRUCKENMILLER, WALTER FRANKLIN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:FRANKLIN
Last Name:DRUCKENMILLER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:FRANK
Other - Middle Name:
Other - Last Name:DRUCKENMILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1275 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5770
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:
Practice Address - Street 1:550 E WASHINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8161
Practice Address - Country:US
Practice Address - Phone:707-465-6925
Practice Address - Fax:707-465-6070
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62101223G0001X
VA04010081051223G0001X
DCDEN58751223G0001X
CA517001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice