Provider Demographics
NPI:1417058827
Name:WALL, JOHN GREGORY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:WALL
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:404 PEOPLE PL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3565
Mailing Address - Country:US
Mailing Address - Phone:434-977-9836
Mailing Address - Fax:434-977-1361
Practice Address - Street 1:404 PEOPLE PL
Practice Address - Street 2:SUITE 301
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3565
Practice Address - Country:US
Practice Address - Phone:434-977-9836
Practice Address - Fax:434-977-1361
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA043201223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics