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Jesserwallddspa

NPI #1104090067 in Danville, Virginia

Provider Information

NPI Number
1104090067
Entity Type
Organization
Organization Name
Jesserwallddspa
Primary Specialty
Dentist
Enumeration Date
Apr 22, 2008
Last Updated
Apr 22, 2008

Practice Location

Address
1045 MAIN ST
Address 2
SUITE 6
City
Danville
State
Virginia
ZIP Code
24541-1800
Phone
(434) 792-8622

Authorized Official

Name
DR. JESSE WALL, DDS
Title
PRESIDENT
Phone
(434) 792-1512

Specialties & Taxonomy Codes

Specialty
Dentist

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