Individual
WILLIAM E WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
10015 FORD AVE, RICHMOND HILL, GA 31324
(912) 756-3880
(912) 756-3516
Mailing address
PO BOX 760, RICHMOND HILL, GA 31324-0760
(912) 756-3880
(912) 756-3516
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9665
GA
Other
Enumeration date
11/02/2012
Last updated
11/02/2012
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