Provider Demographics
NPI:1720273907
Name:WALSH, BRIAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
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 1:370 W COSHOCTON ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-1113
Mailing Address - Country:US
Mailing Address - Phone:740-967-6046
Mailing Address - Fax:740-967-6840
Practice Address - Street 1:370 W COSHOCTON ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-1113
Practice Address - Country:US
Practice Address - Phone:740-967-6046
Practice Address - Fax:740-967-6840
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019452122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist