Provider Demographics
NPI:1629257845
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 1:2258 W ROOSEVELT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-3089
Mailing Address - Country:US
Mailing Address - Phone:704-291-7100
Mailing Address - Fax:704-291-7115
Practice Address - Street 1:2258 W ROOSEVELT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3089
Practice Address - Country:US
Practice Address - Phone:704-291-7100
Practice Address - Fax:704-291-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty