Provider Demographics
NPI:1841306073
Name:WALLS, KIMBERLEY L (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:L
Last Name:WALLS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-1552
Mailing Address - Country:US
Mailing Address - Phone:804-321-0341
Mailing Address - Fax:
Practice Address - Street 1:7032 FOREST HILL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1655
Practice Address - Country:US
Practice Address - Phone:804-321-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-6930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist