Individual
MRS. KATHRINE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
281 S MAIN ST, CENTERVILLE, UT 84014-2292
(801) 292-0733
(801) 298-5336
Mailing address
281 S MAIN ST, CENTERVILLE, UT 84014-2292
(801) 292-0733
(801) 298-5336
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1082790701
UT
Other
Enumeration date
07/12/2006
Last updated
07/08/2007
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