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Individual

DOUGLAS M WALLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2502 GALEN DR, SUITE 103, CHAMPAIGN, IL 61821-7045
(217) 366-0050
Mailing address
2502 GALEN DR, SUITE 103, CHAMPAIGN, IL 61821-7045
(217) 366-0050

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019020653
IL

Other

Enumeration date
07/11/2008
Last updated
07/11/2008
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