Organization
MATTHEW D WALL DDS MSD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW D WALL DDS MSD (OWNER)
(360) 491-7080
Entity
Organization
Contact information
Practice address
5320 CORPORATE CENTER LOOP SE STE A, LACEY, WA 98503-5557
(360) 491-7080
(360) 491-7105
Mailing address
5320 CORPORATE CENTER LOOP SE STE A, LACEY, WA 98503-5557
(360) 491-7080
(360) 491-7105
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
60048046
WA
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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