Provider Demographics
NPI:1801089933
Name:WALSH, CRAIG LOUIS (DMD MS)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:LOUIS
Last Name:WALSH
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 BEACON HILL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011
Mailing Address - Country:US
Mailing Address - Phone:859-331-5796
Mailing Address - Fax:859-572-2271
Practice Address - Street 1:1846 BEACON HILL AVE
Practice Address - Street 2:
Practice Address - City:FORT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011
Practice Address - Country:US
Practice Address - Phone:859-331-5796
Practice Address - Fax:859-572-2271
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist