NPI 1104090067

Jesserwallddspa

Organisation Dentist Danville, VA

Practice location

Address: 1045 Main St Suite 6, Danville, VA 24541-1800
Phone: (434) 792-8622

Authorised official

Name: Jesse Wall
Title: President
Phone: (434) 792-1512

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 5098 (VA)

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Registry record

NPI: 1104090067
Entity type: Organization
NPI issued: 22 Apr 2008
Record last updated: 22 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.