MEDICARE: DOUGLAS P. 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	788510	OTHER		UNITED CONCORDIA
3	WA0505	OTHER	WA	REGENCE BLUE SHIELD RIDER
4	21287	OTHER	WA	LABOR & INDUSTRIES

General Provider Information

NPI Number	:	1245372515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS P. 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	:

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	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DOUGLAS P WALSH
Credential	:	DDS
Telephone Number	:	207-762-8433

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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