Provider Demographics
NPI:1871644013
Name:WALSH, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 MAIN ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-1889
Mailing Address - Country:US
Mailing Address - Phone:770-599-4441
Mailing Address - Fax:770-599-4442
Practice Address - Street 1:42 MAIN ST STE 3B
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-1889
Practice Address - Country:US
Practice Address - Phone:770-599-4441
Practice Address - Fax:770-599-4441
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0127401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice