Provider Demographics
NPI:1639261209
Name:WALKER, MICHAEL STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 S RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-7493
Mailing Address - Country:US
Mailing Address - Phone:812-257-1222
Mailing Address - Fax:
Practice Address - Street 1:2007 MEMORIAL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-3127
Practice Address - Country:US
Practice Address - Phone:812-257-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010078A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice