Individual
BRIAN M WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1048 UNION ST, BANGOR, ME 04401-3016
(207) 992-2152
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN5051
ME
Other
Enumeration date
04/13/2021
Last updated
07/26/2023
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