Provider Demographics
NPI:1821151465
Name:WALKER, MICHAEL GARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GARY
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 1:117 SOUTH KINNEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2702
Mailing Address - Country:US
Mailing Address - Phone:989-773-2133
Mailing Address - Fax:989-779-1054
Practice Address - Street 1:117 S KINNEY AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2702
Practice Address - Country:US
Practice Address - Phone:989-773-2133
Practice Address - Fax:989-779-1054
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI10201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist