Healthcare Provider Details

I. General information

NPI: 1700914827
Provider Name (Legal Business Name): PATRICK J. WALSH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MEMORIAL DR
SCHWENKSVILLE PA
19473-1762
US

IV. Provider business mailing address

105 MEMORIAL DR
SCHWENKSVILLE PA
19473-1762
US

V. Phone/Fax

Practice location:
  • Phone: 610-287-7210
  • Fax: 610-287-8340
Mailing address:
  • Phone: 610-287-7210
  • Fax: 610-287-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS021693L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: