Provider Demographics
NPI:1720211501
Name:EUGENIA A. WALSH, DDS, PC
Entity Type:Organization
Organization Name:EUGENIA A. WALSH, DDS, PC
Other - Org Name:WALSH DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-550-9444
Mailing Address - Street 1:9010 LORTON STATION BLVD.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079
Mailing Address - Country:US
Mailing Address - Phone:703-339-5690
Mailing Address - Fax:703-339-5692
Practice Address - Street 1:9010 LORTON STATION BLVD.
Practice Address - Street 2:SUITE 150
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079
Practice Address - Country:US
Practice Address - Phone:703-339-5690
Practice Address - Fax:703-339-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014121091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty