# RENEE WALL, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RENEE WALL, DDS
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1891171138
- **Legal business name:** RENEE WALL, DDS
- **Authorized official:** DR. RENEE A WALL DDS (OWNER/DENTIST)
- **Authorized official phone:** (919) 362-1394

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6732 | NC | Yes |
| 1223G0001X | General Practice Dentistry | 9328 | NC | — |

## Other

- **Enumeration date:** 08/10/2015
- **Last updated:** 08/10/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 811370 | UNITED CONCORDIA | NC |
| 01 | — | 9008P | BCBS | NC |