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General NPI Number Information
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NPI Number | 1285828343
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Entity Type | Individual
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Provider Name | MEGHAN MAUREEN SULLIVAN WALSH D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 3223 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5007
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Country | US
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Telephone | 215-707-2803
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Fax |
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Provider Business Mailing Address
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Address Line | 128 RIVER DR
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City | TITUSVILLE
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State | NJ
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Zip | 08560-1731
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Country | US
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Telephone | 267-475-7351
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS040751
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License Number State | PA
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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 | 8487
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License Number State | NC
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