Provider Demographics
NPI:1629126487
Name:WALLS, ALLAN TODD (DDS)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:TODD
Last Name:WALLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7304
Mailing Address - Country:US
Mailing Address - Phone:910-763-0931
Mailing Address - Fax:910-763-6405
Practice Address - Street 1:1133 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7304
Practice Address - Country:US
Practice Address - Phone:910-763-0931
Practice Address - Fax:910-763-6405
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37031223G0001X
NC91791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice