| NPI | 1265678510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN P WALLS Owner/President 304-372-4009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3580) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2008-12-16 |