Healthcare Provider Details

I. General information

NPI: 1851316012
Provider Name (Legal Business Name): ELIZABETH CLARE WALSH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/12/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE STREET CINCINNATI VA MEDICAL CENTER
CINCINNATI OH
45220
US

IV. Provider business mailing address

2720 S HIGHLAND AVE APT. 330
LOMBARD IL
60148-5302
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-6308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5628
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: