Individual
DR. ANDREW WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
628 N 1ST ST, LAKEVIEW, OR 97630-1506
(888) 468-0022
(541) 504-3907
Mailing address
442 SW UMATILLA AVE, SUITE 200, REDMOND, OR 97756-7039
(541) 504-3900
(541) 504-3907
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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