MEDICARE: STEVEN R WALLS, DMD A PROFESSIONAL CORPORATION

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1871334458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN R WALLS, DMD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	6040 BRAMBLEWOOD LN
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-9797
Country	:	US
Telephone Number	:	916-939-0889
Fax Number	:

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	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	DR. STEVEN R WALLS
Credential	:	DMD
Telephone Number	:	916-939-0889

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	01/09/2025

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