Individual
ROBERT E WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
753 W MAIN ST, MADISON, IN 47250-3150
(812) 265-5962
(812) 273-1085
Mailing address
753 W MAIN ST, MADISON, IN 47250-3150
(812) 265-5962
(812) 273-1085
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007187
IN
Other
Enumeration date
11/10/2006
Last updated
07/08/2007
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