Individual
WALLACE JEFFREY ERNST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
106 W 5TH STREET, RICEVILLE, IA 50466
(641) 985-2555
(641) 985-2918
Mailing address
PO BOX 99, 106 W 5TH STREET, RICEVILLE, IA 50466
(641) 985-2555
(641) 985-4918
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7059
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1227736
—
IA
01
—
22772
BCBS
IA
Enumeration date
07/24/2006
Last updated
07/08/2007
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