Individual
DR. TIMOTHY RAYMOND WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
250 CLARK ST, PEWAUKEE, WI 53072-3529
(262) 695-9392
Mailing address
250 CLARK ST, PEWAUKEE, WI 53072-3529
(262) 695-9392
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3951-015
WI
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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