Individual
DR. JEFFREY H WALLEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1200 48TH AVE N, SUITE 101, MYRTLE BEACH, SC 29577-5425
(843) 449-4993
(843) 497-0647
Mailing address
1200 48TH AVE N, SUITE 101, MYRTLE BEACH, SC 29577-5425
(843) 449-4993
(843) 497-0647
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
2959
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8998844
—
NC
05
—
ZA9905
—
SC
Enumeration date
02/15/2006
Last updated
07/08/2007
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