Provider Demographics
NPI:1902006802
Name:WALTER P & CAROLYN E MCGINN DMD PC
Entity Type:Organization
Organization Name:WALTER P & CAROLYN E MCGINN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT FOR INFORM
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-928-3723
Mailing Address - Street 1:153 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-2115
Mailing Address - Country:US
Mailing Address - Phone:860-928-3723
Mailing Address - Fax:
Practice Address - Street 1:153 GROVE ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-2115
Practice Address - Country:US
Practice Address - Phone:860-928-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty