Organization
NORTHRISE DENTAL LLC
Active
Other names
Jared Wallis DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARED WALLIS DDS (DENTIST/OWNER)
(575) 521-9375
Entity
Organization
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
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/10/2019
Last updated
01/10/2019
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