Individual
RAYMOND A WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1303 16TH AVE, CLARKSTON, WA 99403-2956
(509) 758-7150
(509) 758-8346
Mailing address
1303 16TH AVE, CLARKSTON, WA 99403-2956
(509) 758-7150
(509) 758-8346
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00007388
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5020086
—
WA
Enumeration date
12/01/2006
Last updated
07/08/2007
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