Provider Demographics
NPI:1457894610
Name:WALKER, MICHAELA (DDS)
Entity type:Individual
Prefix:DR
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 1:470 HIGHLAND AVE STE 1AND2
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2243
Mailing Address - Country:US
Mailing Address - Phone:541-267-6425
Mailing Address - Fax:541-267-4203
Practice Address - Street 1:470 HIGHLAND AVE STE 1AND2
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2243
Practice Address - Country:US
Practice Address - Phone:541-267-6425
Practice Address - Fax:541-267-4203
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR111841223G0001X
CADDS1009681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice