Individual
ASHLEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1 WAHOO AVE, GROTON, CT 06349-2324
(860) 694-3738
Mailing address
1 WAHOO AVE, GROTON, CT 06349-2324
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1857727
MA
Other
Enumeration date
09/25/2017
Last updated
09/25/2017
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