Provider Demographics
NPI:1689960585
Name:WALSH, LAURA MICHELE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELE
Last Name:WALSH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 WYOGA LAKE RD APT 307
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6826
Mailing Address - Country:US
Mailing Address - Phone:440-306-0257
Mailing Address - Fax:
Practice Address - Street 1:6370 SOM CENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2991
Practice Address - Country:US
Practice Address - Phone:440-248-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0234641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice