MEDICARE: DR. DOUGLAS PAUL WALSH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5109	WA

General Provider Information

NPI Number	:	1194728931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS PAUL WALSH DDS

Provider Business Mailing Address
First Line	:	9801 17TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2759
Country	:	US
Telephone Number	:	206-762-8433
Fax Number	:	206-767-5581

Provider Business Practice Location Address
First Line	:	9801 17TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-2759
Country	:	US
Telephone Number	:	206-762-8433
Fax Number	:	206-767-5581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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