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NPI Code Detail

MEDICARE: DR. MARK J. WALSH D.M.D.

MEDICARE:  DR. MARK J. WALSH  D.M.D.
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
11223P0221XPediatric Dentistry37039TX

General Provider Information

NPI Number : 1427581065
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK J. WALSH D.M.D.
Provider Business Mailing Address
First Line : 4S615 KARNS RD
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-1508
Country : US
Telephone Number : 830-358-6353
Fax Number :
Provider Business Practice Location Address
First Line : 7325 FLAT ROCK LN
Second Line :
City : TYLER
State : TX
Zip : 75703-7389
Country : US
Telephone Number : 830-358-3538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2017
Last Update Date : 06/07/2024

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Directions to “ DR. MARK J. WALSH D.M.D.” Practice Location

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