Provider Demographics
NPI:1689032492
Name:WALSKA, JOANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:WALSKA
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 1:3107 NJ- 38
Mailing Address - Street 2:#2
Mailing Address - City:MOUNT LAUREL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-778-0800
Mailing Address - Fax:
Practice Address - Street 1:3107 NJ- 38
Practice Address - Street 2:#2
Practice Address - City:MOUNT LAUREL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-778-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059194122300000X
NJ22DI028312001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist