Provider Demographics
NPI:1346476801
Name:JOHN WALSH DDS PA
Entity Type:Organization
Organization Name:JOHN WALSH DDS PA
Other - Org Name:DENTISTRY OF THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-522-1550
Mailing Address - Street 1:6708 ALBERMARLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-3856
Mailing Address - Country:US
Mailing Address - Phone:704-537-1990
Mailing Address - Fax:704-531-2757
Practice Address - Street 1:6708 ALBERMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-3856
Practice Address - Country:US
Practice Address - Phone:704-537-1990
Practice Address - Fax:704-531-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty