Provider Demographics
NPI:1124089289
Name:WALSTON, DENNIS D (DO)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:WALSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:45 SNELLING AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6842
Mailing Address - Country:US
Mailing Address - Phone:651-326-5650
Mailing Address - Fax:651-326-5671
Practice Address - Street 1:45 SNELLING AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6842
Practice Address - Country:US
Practice Address - Phone:651-326-5650
Practice Address - Fax:651-326-5671
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN28636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA96087Medicare UPIN