Individual
CHARLES COLEMAN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2200 E 4500 S, SUITE 240, SALT LAKE CITY, UT 84117-4437
(801) 278-3864
(801) 278-3868
Mailing address
2200 E 4500 S, SUITE 240, SALT LAKE CITY, UT 84117-4437
(801) 278-3864
(801) 278-3868
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5134366-9922
UT
Other
Enumeration date
07/26/2013
Last updated
07/26/2013
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