Individual
DR. DEDRA DESIREE DAVIS-WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3131 STEIN BLVD, EAU CLAIRE, WI 54701-6978
(715) 835-7172
(713) 490-6464
Mailing address
3131 STEIN BLVD, EAU CLAIRE, WI 54701-6978
(715) 835-7172
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1001197-15
WI
1223P0221X
Pediatric Dentistry
24891
TX
1223P0221X
Pediatric Dentistry
DN012272
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518057934
—
WI
Enumeration date
10/14/2006
Last updated
07/12/2022
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