Provider Demographics
NPI:1922168657
Name:JAKIELA, WALTER E (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:E
Last Name:JAKIELA
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 1:1392 WEIMER ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-758-8654
Mailing Address - Fax:505-737-0970
Practice Address - Street 1:1392 WEIMER ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-8654
Practice Address - Fax:505-737-0970
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist