Individual
DR. DAVID MATTHEW WALLITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
652 HAMILTON ROAD, FORT SILL, OK 73503
(580) 442-3905
Mailing address
652 HAMILTON ROAD, FORT SILL, OK 73503
(580) 442-3905
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8996
SC
1223G0001X
General Practice Dentistry
Primary
8996
SC
Other
Enumeration date
08/15/2017
Last updated
07/20/2018
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