Individual
DR. SHANNON DANIELLE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
8430 PERSHALL RD, HAZELWOOD, MO 63042-3075
(314) 521-5678
Mailing address
8430 PERSHALL RD, HAZELWOOD, MO 63042-3075
(314) 521-5678
(314) 521-0283
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2021021159
MO
Other
Enumeration date
07/06/2021
Last updated
07/06/2021
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