Provider Demographics
NPI:1811377054
Name:WALSH, ASHLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:WALSH
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 1:657 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-1216
Mailing Address - Country:US
Mailing Address - Phone:715-524-2581
Mailing Address - Fax:
Practice Address - Street 1:657 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-1216
Practice Address - Country:US
Practice Address - Phone:715-524-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001653-151223G0001X
NC100731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice