Individual
DR. JOEL RICHARD WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
16727 FARM AVENUE, EAGLE RIVER, AK 99577
(907) 694-4032
Mailing address
16727 FARM AVENUE, EAGLE RIVER, AK 99577
(907) 694-4032
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
519
AK
Other
Enumeration date
05/08/2015
Last updated
05/08/2015
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