Individual
DR. KEVIN MARTIN WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
6651 CHIPPEWA, SUITE 221, ST LOUIS, MO 63109-2531
(314) 351-2588
(314) 351-3334
Mailing address
6651 CHIPPEWA SUITE 221, LANSDOWNE MEDICAL BUILDING, ST LOUIS, MO 63109-2531
(314) 351-2588
(314) 351-3334
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
00580
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2012963
DELTA DENTAL INSURANCE
—
Enumeration date
11/27/2006
Last updated
07/08/2007
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