Provider Demographics
NPI:1821140476
Name:WALP, MICHAEL E (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:WALP
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:PO BOX 268
Mailing Address - Street 2:400 MAIN STREET
Mailing Address - City:HUNTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37345
Mailing Address - Country:US
Mailing Address - Phone:931-469-7343
Mailing Address - Fax:931-469-7372
Practice Address - Street 1:400 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HUNTLAND
Practice Address - State:TN
Practice Address - Zip Code:37345
Practice Address - Country:US
Practice Address - Phone:931-469-7343
Practice Address - Fax:931-469-7372
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 3609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist