Individual
DR. WALLACE H DICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4705 RIVER RD N, KEIZER, OR 97303-4535
(503) 393-3233
(503) 393-3191
Mailing address
PO BOX 21689, KEIZER, OR 97307-1689
(503) 393-3233
(503) 393-3191
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7009
OR
Other
Enumeration date
06/04/2007
Last updated
07/08/2007
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