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General NPI Number Information
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NPI Number | 1982979753
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Entity Type | Organization
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Legal Business Name | RICHARD WALLS, DMD,PC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 2155 POST OAK TRITT RD SUITE 500
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City | MARIETTA
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State | GA
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Zip | 30062-8620
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Country | US
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Telephone | 770-973-1738
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 POST OAK TRITT RD SUITE 500
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City | MARIETTA
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State | GA
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Zip | 30062-8620
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Country | US
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Telephone | 770-973-1738
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD D WALLS
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Credential | DMD
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Telephone | 770-973-1738
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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 | DN010062
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License Number State | GA
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