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1396842589
MICHAEL SHANE WALL
STATESBORO, GA
NPI
1396842589
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics
(Licence: GA DN012729)
Enumeration Date
2006-09-20
Last Update Date
2009-12-14
Business Address
Dr. MICHAEL SHANE WALL D.M.D.
506 GENTILLY ROAD
STATESBORO, GA 30458
Phone number: 912-764-6737
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Mailing Address
Dr. MICHAEL SHANE WALL D.M.D.
506 GENTILLY ROAD
STATESBORO, GA 30458
Phone number: 912-764-6737
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