Provider Demographics
NPI:1902467244
Name:WALSH, EMILY KATHLEEN (DDS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHLEEN
Last Name:WALSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 STATE ROUTE 55 STE 107
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5048
Mailing Address - Country:US
Mailing Address - Phone:845-486-4572
Mailing Address - Fax:
Practice Address - Street 1:1110 STATE ROUTE 55 STE 107
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5048
Practice Address - Country:US
Practice Address - Phone:845-486-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.004083122300000X
OH30.026095122300000X
NY0624351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist