MEDICARE: DR. STEVEN R. WALLS DMD

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
1	122300000X	Dentist	41692	CA

General Provider Information

NPI Number	:	1750477501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN R. WALLS DMD

Provider Business Mailing Address
First Line	:	1010 WHITE ROCK RD STE 500
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-5627
Country	:	US
Telephone Number	:	916-939-0889
Fax Number	:	916-939-0477

Provider Business Practice Location Address
First Line	:	1010 WHITE ROCK RD STE 500
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-5627
Country	:	US
Telephone Number	:	916-939-0889
Fax Number	:	916-939-0477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/09/2025

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