Provider Demographics
NPI:1457894610
Name:WALKER, MICHAELA (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:726 E 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3739
Mailing Address - Country:US
Mailing Address - Phone:909-333-6666
Mailing Address - Fax:
Practice Address - Street 1:726 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3739
Practice Address - Country:US
Practice Address - Phone:909-333-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1165101223G0001X
CADDS1009681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice