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General NPI Number Information
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NPI Number | 1235677204
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Entity Type | Individual
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Provider Name | CHERIE DANIELLE WALSH DMD
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Gender | Female
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 59 W 12TH ST
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City | NEW YORK
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State | NY
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Zip | 10011-8563
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Country | US
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Telephone | 212-373-4651
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Fax |
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Provider Business Mailing Address
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Address Line | 151 HOYT ST # 1F
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City | BROOKLYN
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State | NY
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Zip | 11217-2226
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Country | US
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Telephone | 914-424-9534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02658500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DGD.8900 GD
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0593891-1
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License Number State | NY
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