Individual
DR. DAWN SPRUILL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8401 UNIVERSITY EXECUTIVE DRIVE, SUITE 110, CHARLOTTE, NC 28262-1360
(704) 547-1970
(704) 547-1926
Mailing address
8401 UNIVERSITY EXECUTIVE PARKWAY, SUITE 110, CHARLOTTE, NC 28262
(704) 547-1970
(704) 547-1926
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7191
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7191
NC LICENSE
NC
Enumeration date
09/21/2006
Last updated
07/08/2007
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