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Search › Illinois › General Practice Dentistry

Douglas Wallen

NPI 1407010176 · on the registry since 2008 · sole proprietor

Practice

Address
2502 Galen Dr
Suite 103
Champaign, IL 61821
Phone
(217) 366-0050
Organisation at this address
Rdi Vein Llc
Cornerstone Dental Pllc
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy
General Practice Dentistry
1223G0001X
Licence states on file
IL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2008-07-11

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois