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Organization
WALLIS DENTAL CORPORATION
Active
Organization
WALLIS DENTAL CORPORATION
Active
Other names
Crestview Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH WALLIS DDS (PRESIDENT)
(408) 406-3077
Entity
Organization
Contact information
Practice address
265 CRESTVIEW DR, SANTA CLARA, CA 95050-6503
(408) 248-6777
Mailing address
265 CRESTVIEW DR, SANTA CLARA, CA 95050-6503
(408) 248-6777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
34914
CA
Other
Enumeration date
02/23/2015
Last updated
02/23/2015
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