Provider Demographics
NPI:1598958183
Name:GEORGE R. WALSETH, D.D.S., INC
Entity Type:Organization
Organization Name:GEORGE R. WALSETH, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:WALSETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-963-0663
Mailing Address - Street 1:23 W MICHELTORENA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2509
Mailing Address - Country:US
Mailing Address - Phone:805-963-0663
Mailing Address - Fax:805-963-0663
Practice Address - Street 1:23 W MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2509
Practice Address - Country:US
Practice Address - Phone:805-963-0663
Practice Address - Fax:805-963-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22859261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental