Provider Demographics
NPI:1881960102
Name:WALLS, SARA LAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:LAYNE
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 1:833 SW LEMANS LN STE 234
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4618
Mailing Address - Country:US
Mailing Address - Phone:816-673-3132
Mailing Address - Fax:
Practice Address - Street 1:833 SW LEMANS LN STE 234
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4618
Practice Address - Country:US
Practice Address - Phone:816-673-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS611011223P0300X
MO20110153491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics