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General NPI Number Information
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NPI Number | 1013882323
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Entity Type | Organization
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Legal Business Name | DR. DAVID A. WALLS, INC
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1316 COFFEE RD STE E14
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City | MODESTO
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State | CA
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Zip | 95355-3191
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Country | US
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Telephone | 209-522-9963
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Fax | 209-522-5184
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Provider Business Mailing Address
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Address Line | 1316 COFFEE RD STE E14
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City | MODESTO
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State | CA
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Zip | 95355-3191
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Country | US
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Telephone | 209-522-9963
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Fax | 209-522-5184
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Authorized Official
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Title or Position | BUSINESS ASSISTANT
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Name | THERESA K SHEPPARD
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Credential | RDA
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Telephone | 209-522-9963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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