Organization
DW SMILES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUSTIN WALLACE DDS (OWNER/DENTIST)
(501) 851-1414
Entity
Organization
Contact information
Practice address
1701 CLUB MANOR DR STE 4, MAUMELLE, AR 72113-7401
(501) 851-1414
Mailing address
1701 CLUB MANOR DR STE 4, MAUMELLE, AR 72113-7401
(501) 851-1414
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223719631
—
AR
Enumeration date
03/06/2018
Last updated
03/20/2018
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