Philip A Walczak, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE61157550 Issued in WA

Practice address

9730 3Rd Ave NE Ste 105
Seattle, WA 98115-2023

Phone

(206) 526-1985

Fax

(206) 526-0466

NPI assigned

Jul 1, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Philip a Walczak DDS PLLC

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1497555080
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1245801174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9730 3RD AVE NE STE 105",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981152023",
            "telephone_number": "425-350-8479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9730 3RD AVE NE STE 105",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981152023",
            "telephone_number": "206-526-1985",
            "fax_number": "206-526-0466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1424 Broadway",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982011720",
            "country_code": "US",
            "telephone_number": "425-789-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALCZAK",
        "first_name": "PHILIP",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-01",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE61157550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mohamed Ali Wako
• Trevor Walchenbach, MD
• Bonnie Walchuk, MA, LMFT, ATR
• Gary Alan Walco, PHD
• Kelsie Helen Walczak, DO
• Anna Wald, MD MPH
• Brynna Jean Wald, DPT
• Matthew L Wald
• Dominique E. Waldau, CNM
• Leanna Waldbauer

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; 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.

Verify at the official NPI Registry.