Provider Demographics
NPI:1346412665
Name:WALL, JAMES S (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
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 1:108 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2667
Mailing Address - Country:US
Mailing Address - Phone:508-548-0216
Mailing Address - Fax:508-495-0540
Practice Address - Street 1:108 MAIN ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2667
Practice Address - Country:US
Practice Address - Phone:508-548-0216
Practice Address - Fax:508-495-0540
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice