MEDICARE: JOHN WALSH DDS PA

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346476801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN WALSH DDS PA

Provider Business Mailing Address
First Line	:	6708 ALBERMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-3856
Country	:	US
Telephone Number	:	704-537-1990
Fax Number	:	704-531-2757

Provider Business Practice Location Address
First Line	:	6708 ALBERMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-3856
Country	:	US
Telephone Number	:	704-537-1990
Fax Number	:	704-531-2757

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MRS. JESSICA JOHNSTON
Credential	:
Telephone Number	:	704-522-1550

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	07/24/2013

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