Provider Demographics
NPI:1750477501
Name:WALLS, STEVEN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:WALLS
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 1:3941 PARK DR
Mailing Address - Street 2:SUITE 50
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4549
Mailing Address - Country:US
Mailing Address - Phone:916-939-0889
Mailing Address - Fax:916-939-0477
Practice Address - Street 1:3941 PARK DR
Practice Address - Street 2:SUITE 50
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4549
Practice Address - Country:US
Practice Address - Phone:916-939-0889
Practice Address - Fax:916-939-0477
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
CA416921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice