Individual
DR. BRAD J WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1001 SW HIGGINS, SUITE 107, MISSOULA, MT 59803
(406) 728-6068
(406) 829-0868
Mailing address
1001 SW HIGGINS, SUITE 107, MISSOULA, MT 59803
(406) 728-6068
(406) 829-0868
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
MT1999
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112242
—
MT
Enumeration date
09/14/2006
Last updated
07/08/2007
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