Individual
DR. MATTHEW TYLER WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
174 CREPE MYRTLE DR, AIKEN, SC 29803-7543
(803) 641-3883
Mailing address
174 CREPE MYRTLE DR, AIKEN, SC 29803-7543
(803) 641-3883
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DGD.9871GD
SC
1223G0001X
General Practice Dentistry
DN016114
GA
Other
Enumeration date
02/17/2020
Last updated
05/10/2022
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