| Organization Name: | ANDREW J. WALLS DDS, PC |
| NPI Number: | 1588805295 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREW JAMES WALLS (PRESIDENT) |
| Mailing Address: | 1019 N Council Ave Suite #2 Blanchard |
| State: | OK US |
| Postal Code: | 730108003 |
| Phone Number: | 4054856080 |
| Fax Number: | 4054856089 |
| NPI Enumeration Date: | 03/11/2009 |
| NPI Last Update Date: | 03/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 5630 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |