Individual
DR. JARED S. WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2540 N TELSHOR BLVD STE E, LAS CRUCES, NM 88011-8201
(575) 521-9375
(575) 521-2637
Mailing address
2540 N TELSHOR BLVD STE E, LAS CRUCES, NM 88011-8201
(575) 521-9375
(575) 521-2637
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3512
NM
1223G0001X
General Practice Dentistry
3512
NM
Other
Enumeration date
07/11/2011
Last updated
02/11/2019
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