Provider Demographics
NPI:1740263094
Name:WALN, LUKE E (DDS)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:E
Last Name:WALN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25477 MAIN ST
Mailing Address - Street 2:P.O BOX 454
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-5001
Mailing Address - Country:US
Mailing Address - Phone:218-963-6330
Mailing Address - Fax:218-963-6332
Practice Address - Street 1:25477 MAIN ST
Practice Address - Street 2:NISSWA SMILES
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-5001
Practice Address - Country:US
Practice Address - Phone:218-963-6330
Practice Address - Fax:218-963-6332
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN