Individual
RICHARD WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4750 S PADRE ISLAND DR STE 101, CORPUS CHRISTI, TX 78411-4416
(361) 371-8555
Mailing address
1 HERMANN PARK CT APT 833, HOUSTON, TX 77021-2449
(903) 216-6653
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
36650
TX
Other
Enumeration date
05/18/2022
Last updated
05/18/2022
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