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Organization

RENEE WALL, DDS, PA

Active
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Organization

RENEE WALL, DDS, PA

Active
Parent organization
RENEE WALL, DDS
Organization subpart
Yes

Provider details

NPI number
Legal business name
RENEE WALL, DDS
Authorized official
DR. RENEE A WALL DDS (OWNER/DENTIST)
(919) 362-1394
Entity
Organization

Contact information

Practice address
100 HYANNIS DR, HOLLY SPRINGS, NC 27540-8327
(919) 362-1394
Mailing address
100 HYANNIS DR, HOLLY SPRINGS, NC 27540-8327
(919) 362-1394

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6732
NC
1223G0001X
General Practice Dentistry
9328
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
—
811370
UNITED CONCORDIA
NC
01
—
9008P
BCBS
NC
Enumeration date
08/10/2015
Last updated
08/10/2015
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