Provider Demographics
NPI:1396049714
Name:JOHN WALSH DDS PA
Entity type:Organization
Organization Name:JOHN WALSH DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-522-1550
Mailing Address - Street 1:1711 MONTFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3721
Mailing Address - Country:US
Mailing Address - Phone:704-527-2440
Mailing Address - Fax:704-527-2406
Practice Address - Street 1:1711 MONTFORD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3721
Practice Address - Country:US
Practice Address - Phone:704-527-2440
Practice Address - Fax:704-527-2406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN WALSH DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty