Provider Demographics
NPI:1245372515
Name:DOUGLAS P. WALSH DDS
Entity type:Organization
Organization Name:DOUGLAS P. WALSH DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-762-8433
Mailing Address - Street 1:9801 17TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2759
Mailing Address - Country:US
Mailing Address - Phone:206-762-8433
Mailing Address - Fax:
Practice Address - Street 1:9801 17TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2759
Practice Address - Country:US
Practice Address - Phone:206-762-8433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA51091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5562806Medicaid
788510OtherUNITED CONCORDIA
WAWA0505OtherREGENCE BLUE SHIELD RIDER
WA21287OtherLABOR & INDUSTRIES