Provider Demographics
NPI:1619063831
Name:WALL, WILLIAM A III (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:WALL
Suffix:III
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 1:230 E 10TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5784
Mailing Address - Country:US
Mailing Address - Phone:256-236-3985
Mailing Address - Fax:
Practice Address - Street 1:230 E 10TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5784
Practice Address - Country:US
Practice Address - Phone:256-236-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice