Individual
IAN WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
216 SEA CLIFF AVE, SEA CLIFF, NY 11579-1232
(363) 777-9690
Mailing address
9 CLAIRE LN, SAYVILLE, NY 11782-2420
(631) 766-7279
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0401417767
VA
1223G0001X
General Practice Dentistry
Primary
064923
NY
1223G0001X
General Practice Dentistry
DN10000220
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2021
Last updated
08/06/2025
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