Individual
DR. MATTHEW D WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
5320 CORPORATE CENTER LOOP SE, LACEY, WA 98503-5557
(360) 491-7080
Mailing address
5320 CORPORATE CENTER LOOP SE, LACEY, WA 98503-5557
(360) 491-7080
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DE60048046
WA
Other
Enumeration date
10/31/2009
Last updated
11/02/2009
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