Provider Demographics
NPI:1811353923
Name:MARK V WALKER DDS, PLLC
Entity type:Organization
Organization Name:MARK V WALKER DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:V
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-838-9333
Mailing Address - Street 1:32114 1ST AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5760
Mailing Address - Country:US
Mailing Address - Phone:253-838-9333
Mailing Address - Fax:
Practice Address - Street 1:32114 1ST AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5760
Practice Address - Country:US
Practice Address - Phone:253-838-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty