Provider Demographics
NPI:1992363907
Name:WALSH, EDWARD JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:WALSH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1617
Mailing Address - Country:US
Mailing Address - Phone:330-480-3195
Mailing Address - Fax:330-480-1366
Practice Address - Street 1:1001 COVINGTON ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1617
Practice Address - Country:US
Practice Address - Phone:330-480-3195
Practice Address - Fax:330-480-1366
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist