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Organization

D & A WALLACE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ANDREA LAYNE WALLACE D.M.D. (SECRETARY/OWNER)
(208) 365-3534
Entity
Organization

Contact information

Practice address
2003 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-3534
(208) 365-6231
Mailing address
2003 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-3534
(208) 365-6231

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3656
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8071026
ID
Enumeration date
02/20/2008
Last updated
02/20/2008
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