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NPI Code Detail

MEDICARE: DR. SHANNON ELIZABETH WALSH DMD

MEDICARE: DR. SHANNON ELIZABETH WALSH DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice DentistryDN1859120MA

General Provider Information

NPI Number : 1235722794
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON ELIZABETH WALSH DMD
Provider Business Mailing Address
First Line : 8 JANET LN
Second Line :
City : PEABODY
State : MA
Zip : 01960-5000
Country : US
Telephone Number : 978-532-1305
Fax Number :
Provider Business Practice Location Address
First Line : 11 EAST ST
Second Line :
City : MIDDLETON
State : MA
Zip : 01949-1506
Country : US
Telephone Number : 978-817-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2021
Last Update Date : 05/08/2022

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