Provider Demographics
NPI:1114465267
Name:WALSH, ERIN (RDH MPH)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RDH MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 DRYDOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-2384
Mailing Address - Country:US
Mailing Address - Phone:888-782-7820
Mailing Address - Fax:
Practice Address - Street 1:21 DRYDOCK AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2384
Practice Address - Country:US
Practice Address - Phone:888-782-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA87820124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist