Individual
DR. DAVID ALLEN WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
206 S WALKER ST, PRINCETON, WV 24740-2747
(304) 425-2611
Mailing address
206 S WALKER ST, PRINCETON, WV 24740-2747
(304) 425-2611
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401003440
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1880
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0138333000
—
WV
05
—
800476
—
VA
Enumeration date
08/11/2005
Last updated
07/08/2007
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