# DAVID A. WALLACE, DDS, MS, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356536593
- **Authorized official:** ELLA HURST (OFC. MNGR.)
- **Authorized official phone:** (304) 425-2611

## Contact information

- **Practice address:** 3712 S MAIN ST, BLACKSBURG, VA 24060-7017
- **Practice address phone:** (540) 552-7222
- **Practice address fax:** (540) 953-3096
- **Mailing address:** 3712 S MAIN ST, BLACKSBURG, VA 24060-7017
- **Mailing address phone:** (540) 552-7222
- **Mailing address fax:** (540) 953-3096

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 03440 | VA | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 1880 | WV | — |

## Other

- **Enumeration date:** 09/11/2007
- **Last updated:** 09/06/2023