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General NPI Number Information
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NPI Number | 1598958183
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Entity Type | Organization
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Legal Business Name | GEORGE R. WALSETH, D.D.S., INC
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 23 W MICHELTORENA ST
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City | SANTA BARBARA
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State | CA
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Zip | 93101-2509
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Country | US
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Telephone | 805-963-0663
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Fax | 805-963-0566
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Provider Business Mailing Address
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Address Line | 23 W MICHELTORENA ST
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City | SANTA BARBARA
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State | CA
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Zip | 93101-2509
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Country | US
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Telephone | 805-963-0663
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Fax | 805-963-0663
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Authorized Official
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Title or Position | CORPORATION
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Name | DR. GEORGE REYNOLDS WALSETH
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Credential | D.D.S.
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Telephone | 805-963-0663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22859
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License Number State | CA
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