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NPI Code Detail

MEDICARE: ROBERT E WALL DDS, PC

MEDICARE: ROBERT E WALL DDS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry12007187IN

General Provider Information

NPI Number : 1255402665
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT E WALL DDS, PC
Provider Business Mailing Address
First Line : 753 W MAIN ST
Second Line :
City : MADISON
State : IN
Zip : 47250-3150
Country : US
Telephone Number : 812-265-5962
Fax Number : 812-273-1085
Provider Business Practice Location Address
First Line : 753 W MAIN ST
Second Line :
City : MADISON
State : IN
Zip : 47250-3150
Country : US
Telephone Number : 812-265-5962
Fax Number : 812-273-1085
Authorized Official
Title or Position : OWNER
Name : ROBERT E WALL
Credential : DDS
Telephone Number : 812-265-5962
Provider Enumeration Date : 11/10/2006
Last Update Date : 08/22/2020

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Directions to “ROBERT E WALL DDS, PC ” Practice Location

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