Active NPI
Michael J Walker, DDS
- Endodontics
- Las Vegas, NV
National Provider Identifier
1073543252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 2375
- Practice address
- 2295 Renaissance Dr Ste C
Las Vegas, NV 89119-6171 - Phone
- (702) 798-0911
- Fax
- (702) 798-0911
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 2375 | NV | Primary |
Addresses
Primary practice location
2295 Renaissance Dr Ste C
Las Vegas, NV 89119-6171
Mailing address
2901 La Mesa Dr
Henderson, NV 89014-3718
Phone (702) 798-0911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150616001872 | VA | Order and Referring Only - Other (Physician) | 9537470646 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2375 | NV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073543252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 LA MESA DR",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890143718",
"telephone_number": "702-798-0911",
"fax_number": "702-798-4723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2295 RENAISSANCE DR STE C",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891196171",
"telephone_number": "702-798-0911",
"fax_number": "702-798-0911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALKER",
"first_name": "MICHAEL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NV",
"license": "2375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.