Individual
DR. MICHAEL SHANE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
506 GENTILLY ROAD, STATESBORO, GA 30458
(912) 764-6737
(912) 489-4848
Mailing address
506 GENTILLY ROAD, STATESBORO, GA 30458
(912) 764-6737
(912) 489-4848
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN012729
GA
Other
Enumeration date
09/20/2006
Last updated
12/14/2009
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