Individual
TIANNA WALLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20440 ROUTE 19, CRANBERRY TWP, PA 16066-7543
(724) 772-9688
Mailing address
20440 ROUTE 19, CRANBERRY TWP, PA 16066-7543
(724) 772-9688
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DS044826
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/27/2023
Last updated
08/25/2025
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