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
1	1223P0221X	Pediatric Dentistry	37039	TX

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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