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Individual
DR. ANDREW WALLS
Active
Individual
DR. ANDREW WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5630
OK
122300000X
Dentist
Primary
D7828
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1305630
—
OK
Enumeration date
06/21/2005
Last updated
01/23/2015
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