| Matthew D Wall Dds Msd Pllc | |
|
5320 Corporate Center Loop Se Ste A Lacey WA 98503-5557 | |
| (360) 491-7080 | |
| (360) 491-7105 |
| Full Name | Matthew D Wall Dds Msd Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 5320 Corporate Center Loop Se Ste A, Lacey, Washington |
| Authorized Official Name and Position | Matthew D Wall (OWNER) |
| Authorized Official Contact | 3604917080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Matthew D Wall Dds Msd Pllc 5320 Corporate Center Loop Se Ste A Lacey WA 98503-5557 Ph: (360) 491-7080 | Matthew D Wall Dds Msd Pllc 5320 Corporate Center Loop Se Ste A Lacey WA 98503-5557 Ph: (360) 491-7080 |
| NPI Number | 1962888636 |
|---|---|
| Provider Enumeration Date | 08/05/2015 |
| Last Update Date | 08/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962888636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 60048046 (Washington) | Primary |
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