Christopher Ryan Walsh, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2901021075 Issued in MI

Practice address

6401 Citation Dr
Clarkston, MI 48346-2992

Phone

(248) 625-3603

Fax

(248) 625-7164

NPI assigned

Aug 6, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clarkston Pediatric Dentistry PLC

  • Dental Clinic/Center
  • Clarkston, MI
  • NPI 1568852382
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425168000000",
    "number": "1104082437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6401 CITATION DR",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462992",
            "telephone_number": "248-625-3603",
            "fax_number": "248-625-7164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 CITATION DR",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462992",
            "telephone_number": "248-625-3603",
            "fax_number": "248-625-7164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "CHRISTOPHER",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-06",
        "last_updated": "2015-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011682A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Monica Walker, RN
• Rebecca Sue Walker, LLPC
• Virginia E Walker, MA CCC SLP
• Melissa Renee Walter
• Doris Eva Mae Ward, LPC
• Rebecca Lynn Warner, RPT
• Heidi Warrington
• Waterford Hearing Center, LLC

• All providers in Clarkston, MI
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.