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Individual

DR. GLENDA LOYD WALLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.D.S

Contact information

Practice address
7730 WOLF RIVER BLVD, SUITE 104, GERMANTOWN, TN 38138-1708
(901) 755-6440
(901) 755-6436
Mailing address
7730 WOLF RIVER BLVD, SUITE 104, GERMANTOWN, TN 38138-1708
(901) 755-6440
(901) 755-6436

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS4635
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
621683022
TAX ID #
TN
Enumeration date
04/16/2007
Last updated
12/03/2010
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