Provider Demographics
NPI:1659591303
Name:DR. WILLIAM A. WALL, D.M.D, PC
Entity Type:Organization
Organization Name:DR. WILLIAM A. WALL, D.M.D, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:256-236-3985
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty