Provider Demographics
NPI:1871334458
Name:STEVEN R WALLS, DMD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:STEVEN R WALLS, DMD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-939-0889
Mailing Address - Street 1:6040 BRAMBLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9797
Mailing Address - Country:US
Mailing Address - Phone:916-939-0889
Mailing Address - Fax:
Practice Address - Street 1:1010 WHITE ROCK RD STE 500
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5627
Practice Address - Country:US
Practice Address - Phone:916-939-0889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental