# DR. JEFFREY SAMUEL WALLIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1528371507
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI02571300 | NJ | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 22DI02571301 | NJ | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DS038160 | PA | — |

## Other

- **Enumeration date:** 07/20/2010
- **Last updated:** 10/30/2014