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Organization

RENEE WALL, DDS, PA

Active
Parent organization
RENEE WALL, DDS
Organization subpart
Yes

Provider details

NPI number
Legal business name
RENEE WALL, DDS
Authorized official
DR. RENEE A WALL DDS (OWNER/DENTIST)
(919) 362-1394
Entity
Organization

Contact information

Practice address
100 HYANNIS DR, HOLLY SPRINGS, NC 27540-8327
(919) 362-1394
Mailing address
100 HYANNIS DR, HOLLY SPRINGS, NC 27540-8327
(919) 362-1394

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6732
NC
1223G0001X
General Practice Dentistry
9328
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
811370
UNITED CONCORDIA
NC
01
9008P
BCBS
NC
Enumeration date
08/10/2015
Last updated
08/10/2015
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