Provider Demographics
NPI:1013341791
Name:DENNIS B WALL DMD PC
Entity Type:Organization
Organization Name:DENNIS B WALL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-534-0173
Mailing Address - Street 1:47 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-1618
Mailing Address - Country:US
Mailing Address - Phone:978-297-1050
Mailing Address - Fax:
Practice Address - Street 1:47 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-1618
Practice Address - Country:US
Practice Address - Phone:978-297-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17147261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental