Provider Demographics
NPI:1811598659
Name:WALKE DENTISTRY PLLC - SERIES 1
Entity Type:Organization
Organization Name:WALKE DENTISTRY PLLC - SERIES 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:WALKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-832-8608
Mailing Address - Street 1:27428 IMPALA RD
Mailing Address - Street 2:
Mailing Address - City:GARBER
Mailing Address - State:IA
Mailing Address - Zip Code:52048-8107
Mailing Address - Country:US
Mailing Address - Phone:641-832-8608
Mailing Address - Fax:
Practice Address - Street 1:511 N BLUFF ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:IA
Practice Address - Zip Code:52052-9465
Practice Address - Country:US
Practice Address - Phone:641-832-8608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center