Provider Demographics
NPI:1891029849
Name:WALLEN, TERRY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:R
Last Name:WALLEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:118 SW 330TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-6185
Mailing Address - Country:US
Mailing Address - Phone:253-838-0765
Mailing Address - Fax:253-838-3416
Practice Address - Street 1:118 SW 330TH ST
Practice Address - Street 2:STE 200
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-6185
Practice Address - Country:US
Practice Address - Phone:253-838-0765
Practice Address - Fax:253-838-3416
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA42721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics