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General NPI Number Information
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NPI Number | 1598609117
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Entity Type | Organization
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Legal Business Name | WALNUT DENTAL, INC
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Dates
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Enumeration Date | 04/15/2026
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 80 TOWN LINE RD STE 7C
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City | ROCKY HILL
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State | CT
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Zip | 06067-1249
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 5 MOUNT ROYAL AVE STE 300
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1900
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HR SPECIALIST
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Name | ALEXA STAPIN
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Credential |
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Telephone | 508-872-3072
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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