Provider Demographics
NPI:1164794491
Name:WILLIAM H. WALLS, D.D.S., P.C.
Entity Type:Organization
Organization Name:WILLIAM H. WALLS, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-548-1919
Mailing Address - Street 1:656 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5213
Mailing Address - Country:US
Mailing Address - Phone:757-548-1919
Mailing Address - Fax:757-548-4492
Practice Address - Street 1:656 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5213
Practice Address - Country:US
Practice Address - Phone:757-548-1919
Practice Address - Fax:757-548-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007229261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental