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Active NPI 1255402665 Organization (Entity Type 2)

Robert E Wall Dds, Pc

Dentist - General Practice • Madison, IN

About Robert E Wall Dds, Pc NPI 1255402665 Summary

Robert E Wall Dds, Pc is a verified healthcare organization specializing in Dentist - General Practice operating in Madison, IN. Located at 753 W MAIN ST, this facility provides patient care and medical services under National Provider Identifier (NPI) 1255402665.

Administrative operations and authorized compliance are overseen by Robert Wall (Owner).

The facility is associated with 2 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

753 W Main St

Madison, IN 472503150

Telephone 8122655962
Fax 8122731085

Authorized Official Information

Authorized Contact Name

Robert Wall , DDS

Title / Role

Owner

Official Telephone

8122655962

Facility Classifications & Specialties

Dentist - General Practice Primary Taxonomy

NUCC Taxonomy Code: 1223G0001X

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

2 Linked

Dentist - General Practice

Madison, IN

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 753 W MAIN ST, MADISON, IN 472503150 (Tel: 8122655962)

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Updated Business Mailing Address July 08, 2007

Registered at 753 W MAIN ST, MADISON, IN 472503150 (Tel: 8122655962)

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Organization / Clinic Name Updated July 08, 2007

Operating as ROBERT E WALL DDS, PC

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #12007187 in IN)

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Initial NPI Registration & Enumeration November 10, 2006

First registered as active Healthcare Organization in NPPES Database.

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NPI Organization Metadata

NPI Number: 1255402665
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: November 10, 2006
Last Update: August 22, 2020

Mailing Address

753 W Main St

Madison, IN 472503150

Phone: 8122655962

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.