Provider Demographics
NPI:1649777558
Name:WALSHE, JAMES DAVID
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:WALSHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2029
Mailing Address - Country:US
Mailing Address - Phone:516-547-1991
Mailing Address - Fax:
Practice Address - Street 1:142 WALNUT ST
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2029
Practice Address - Country:US
Practice Address - Phone:516-547-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0604091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice