Organization
TERRACE HILL DENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FELDER E WALLACE DDS (DENTIST/CO-OWNER)
(601) 264-5756
Entity
Organization
Contact information
Practice address
6654 U S HIGHWAY 98, HATTIESBURG, MS 39402-7936
(601) 264-5756
(601) 264-5013
Mailing address
6654 U S HIGHWAY 98, HATTIESBURG, MS 39402-7936
(601) 264-5756
(601) 264-5013
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1771.77
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1771-77
DENTIST LICENSE NUMBER
MS
Enumeration date
08/02/2006
Last updated
10/02/2017
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