Kelin Walsh, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

22DI02881500 Issued in NJ

Practice address

10 Broad St
Bloomfield, NJ 07003-2524

Phone

(973) 744-7003

NPI assigned

Apr 10, 2023

Last updated

Apr 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kindersmile Community Oral Health Center

  • Health Maintenance Organization
  • Bloomfield, NJ
  • NPI 1497106090
  NPD (past)

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681084800000",
    "number": "1336834092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 PELTON AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103103009",
            "telephone_number": "347-466-1360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032524",
            "telephone_number": "973-744-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "KELIN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-10",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02881500",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN26374",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Ann Waldron, PSY.D.
• Shiloh O Waldron, LCSW
• Walgreen Co (Walgreens #19964)
• Walgreen Eastern Co, Inc (Walgreens #01881)
• Cheryl Walker
• Constance A Walwyn
• Maggie Wanis
• Wardian Health LLC
• Amelia Washington, LAC
• April Waterman, RN IBCLC

• Dentist in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.