Provider Demographics
NPI:1073844338
Name:WALLING DENTAL CENTER
Entity Type:Organization
Organization Name:WALLING DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-657-5204
Mailing Address - Street 1:11765 MCMINNVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:WALLING
Mailing Address - State:TN
Mailing Address - Zip Code:38587-5040
Mailing Address - Country:US
Mailing Address - Phone:931-657-5204
Mailing Address - Fax:931-657-2134
Practice Address - Street 1:11765 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:WALLING
Practice Address - State:TN
Practice Address - Zip Code:38587-5040
Practice Address - Country:US
Practice Address - Phone:931-657-5204
Practice Address - Fax:931-657-2134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS19971223G0001X
TNDS41721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty