Provider Demographics
NPI:1114091915
Name:BRIAN J WALSH DDS INC
Entity Type:Organization
Organization Name:BRIAN J WALSH DDS INC
Other - Org Name:JOHNSTOWN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-967-6046
Mailing Address - Street 1:370 WEST COSHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031
Mailing Address - Country:US
Mailing Address - Phone:740-967-6046
Mailing Address - Fax:740-967-6840
Practice Address - Street 1:370 WEST COSHOCTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031
Practice Address - Country:US
Practice Address - Phone:740-967-6046
Practice Address - Fax:740-967-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019452122300000X
OH30020098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty