Individual
DAKOTA JAMES WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
194 POPLAR CT, COLUMBIA, KY 42728-8460
(812) 801-5784
Mailing address
194 POPLAR CT, COLUMBIA, KY 42728-8460
(812) 801-5784
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/08/2025
Last updated
09/08/2025
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