Provider Demographics
NPI:1871835447
Name:WALKER, MARISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MIDDLEFIELD ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-328-2072
Mailing Address - Fax:650-321-8337
Practice Address - Street 1:150 MIDDLEFIELD ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-321-4544
Practice Address - Fax:650-321-8337
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist