Individual
DR. JENNIFER KRISTINE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
BEAUFORT NAVAL HOSPITAL, 1 PICKNEY AVE, BEAUFORT, SC 29902
(843) 228-3500
Mailing address
225 DISTANT ISLAND DR, BEAUFORT, SC 29907-1558
(843) 986-1071
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3538
SC
Other
Enumeration date
08/25/2005
Last updated
07/08/2007
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