Provider Demographics
NPI:1609958925
Name:M WALKER DDS ASSOCIATES OF NORTHDALE PA
Entity Type:Organization
Organization Name:M WALKER DDS ASSOCIATES OF NORTHDALE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-960-8896
Mailing Address - Street 1:3910 NORTHDALE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625
Mailing Address - Country:US
Mailing Address - Phone:813-969-0294
Mailing Address - Fax:813-969-1339
Practice Address - Street 1:3910 NORTHDALE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625
Practice Address - Country:US
Practice Address - Phone:813-969-0294
Practice Address - Fax:813-969-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty