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General NPI Number Information
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NPI Number | 1770938300
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Entity Type | Organization
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Legal Business Name | LAURA M. WALSH, DMD, INC.
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 6370 SOM CENTER RD STE 100
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City | SOLON
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State | OH
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Zip | 44139-2991
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Country | US
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Telephone | 440-248-6823
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Fax | 440-248-9030
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Provider Business Mailing Address
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Address Line | 6370 SOM CENTER RD STE 100
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City | SOLON
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State | OH
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Zip | 44139-2991
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Country | US
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Telephone | 440-248-6823
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Fax | 440-248-9030
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURA M WALSH
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Credential | DMD
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Telephone | 440-248-6823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.023464
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License Number State | OH
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