Provider Demographics
NPI:1144382326
Name:WALL, FRANK A (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:WALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2142
Mailing Address - Country:US
Mailing Address - Phone:256-760-9898
Mailing Address - Fax:
Practice Address - Street 1:334 W CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2142
Practice Address - Country:US
Practice Address - Phone:256-760-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice