| Organization Name: | WALLS FAMILY DENTISTRY, INC |
| NPI Number: | 1679740898 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW WALLS (PRESIDENT/DENTIST) |
| Mailing Address: | 12627 S Highway 51 Coweta |
| State: | OK US |
| Postal Code: | 744296476 |
| Phone Number: | 9184860039 |
| Fax Number: | 9184860097 |
| NPI Enumeration Date: | 05/15/2008 |
| NPI Last Update Date: | 03/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | OK5393 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |