Individual
MATTHEW WALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3985 MAIN ST, AMHERST, NY 14226-3404
(716) 832-1550
Mailing address
3985 MAIN ST, AMHERST, NY 14226-3404
(716) 832-1550
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
055170
NY
Other
Enumeration date
08/18/2011
Last updated
08/18/2011
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