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Organization
DAVID A. WALLACE, DDS, MS, LTD.
Active
Organization
DAVID A. WALLACE, DDS, MS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLA HURST (OFC. MNGR.)
(304) 425-2611
Entity
Organization
Contact information
Practice address
3712 S MAIN ST, BLACKSBURG, VA 24060-7017
(540) 552-7222
(540) 953-3096
Mailing address
3712 S MAIN ST, BLACKSBURG, VA 24060-7017
(540) 552-7222
(540) 953-3096
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
03440
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
1880
WV
Other
Enumeration date
09/11/2007
Last updated
09/06/2023
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