Provider Demographics
NPI:1982786208
Name:M WALKER DDS PA
Entity Type:Organization
Organization Name:M WALKER DDS PA
Other - Org Name:DENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-926-5700
Mailing Address - Street 1:4620 N HABANA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7107
Mailing Address - Country:US
Mailing Address - Phone:813-877-7353
Mailing Address - Fax:813-875-6840
Practice Address - Street 1:4620 N HABANA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7107
Practice Address - Country:US
Practice Address - Phone:813-877-7353
Practice Address - Fax:813-875-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty