Provider Demographics
NPI:1285810499
Name:WALLS, DAVID ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALAN
Last Name:WALLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MORNINGSIDE DR
Mailing Address - Street 2:APT. 1203
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2422
Mailing Address - Country:US
Mailing Address - Phone:646-784-2044
Mailing Address - Fax:
Practice Address - Street 1:959 BRUSH HOLLOW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1778
Practice Address - Country:US
Practice Address - Phone:516-333-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0561391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery