Individual
MS. CARLY WALZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
302 SUFFIELD ST, AGAWAM, MA 01001-1749
(413) 786-0085
Mailing address
302 SUFFIELD ST, AGAWAM, MA 01001-1749
(413) 786-0085
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1859890
MA
Other
Enumeration date
03/24/2023
Last updated
08/04/2023
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