Provider Demographics
NPI:1245202316
Name:WALSH, RICHARD DANA (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANA
Last Name:WALSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 S COUNTY TRL
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3182
Mailing Address - Country:US
Mailing Address - Phone:401-364-6300
Mailing Address - Fax:401-364-9190
Practice Address - Street 1:4995 S COUNTY TRL
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02813-3182
Practice Address - Country:US
Practice Address - Phone:401-364-6300
Practice Address - Fax:401-364-9190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist