Individual
DR. DANIEL JAMES WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
N63W23401 MAIN ST, SUSSEX, WI 53089
(262) 246-6806
Mailing address
435 WELLS ST APT 207, DELAFIELD, WI 53018-1465
(414) 460-7456
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1001877-15
WI
Other
Enumeration date
03/29/2018
Last updated
06/28/2018
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