Provider Demographics
NPI:1639377484
Name:WALSETH, GEORGE REYNOLDS I (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:REYNOLDS
Last Name:WALSETH
Suffix:I
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 1:23 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:805-963-0566
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA228591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice