Healthcare Provider Details

I. General information

NPI: 1386638229
Provider Name (Legal Business Name): EUGENIA AUKHERT WALSH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 LORTON STATION BLVD SUITE 150
LORTON VA
22079-4792
US

IV. Provider business mailing address

9010 LORTON STATION BLVD SUITE 150
LORTON VA
22079-4792
US

V. Phone/Fax

Practice location:
  • Phone: 703-339-5690
  • Fax: 703-339-5692
Mailing address:
  • Phone: 703-339-5690
  • Fax: 703-339-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401412109
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: