Provider Demographics
NPI:1376626069
Name:WALSH, WENDY LYNNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:LYNNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243511 W HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-9472
Mailing Address - Country:US
Mailing Address - Phone:360-452-6252
Mailing Address - Fax:360-452-6274
Practice Address - Street 1:243511 W HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-9472
Practice Address - Country:US
Practice Address - Phone:360-452-6252
Practice Address - Fax:360-452-6274
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist