Provider Demographics
NPI:1588672372
Name:WALSH, FRANK R (DMD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:R
Last Name:WALSH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:31 WEST GROVE ST
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-0192
Mailing Address - Country:US
Mailing Address - Phone:508-947-7500
Mailing Address - Fax:508-947-0477
Practice Address - Street 1:31 WEST GROVE STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1806
Practice Address - Country:US
Practice Address - Phone:508-947-7500
Practice Address - Fax:508-947-0477
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX06127OtherBCBS
MA0272027Medicaid