Provider Demographics
NPI:1588718068
Name:WALZ, JOSEPH A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:WALZ
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 1:1 SOUTH END BRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3355
Mailing Address - Country:US
Mailing Address - Phone:410-137-8600
Mailing Address - Fax:413-786-0025
Practice Address - Street 1:1 SOUTH END BRIDGE CIR
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3355
Practice Address - Country:US
Practice Address - Phone:410-137-8600
Practice Address - Fax:413-786-0025
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice