Provider Demographics
NPI:1588993281
Name:WALLS, JAROD LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAROD
Middle Name:LEE
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 1:19 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8087
Mailing Address - Country:US
Mailing Address - Phone:740-773-4066
Mailing Address - Fax:740-773-9174
Practice Address - Street 1:19 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8087
Practice Address - Country:US
Practice Address - Phone:740-773-4066
Practice Address - Fax:740-773-9174
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0230681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice