Provider Demographics
NPI:1871933325
Name:WALKER, SALLY JAYE
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:JAYE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1024 AIPOOLA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96708-3956
Mailing Address - Country:US
Mailing Address - Phone:239-287-0088
Mailing Address - Fax:
Practice Address - Street 1:91-1024 AIPOOLA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3956
Practice Address - Country:US
Practice Address - Phone:239-287-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH18295124Q00000X
OH31.011390124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist