Individual
DR. WALLACE TAYLOR VANNORTWICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7942 GOODWOOD BLVD, BATON ROUGE, LA 70806-7629
(225) 925-1517
Mailing address
7942 GOODWOOD BLVD, BATON ROUGE, LA 70806-7629
(225) 925-1517
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
3211
LA
1223P0700X
Prosthodontics
DN 8075
FL
Other
Enumeration date
01/31/2007
Last updated
07/08/2007
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