Individual
DANE E WALLSMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3415 S LAFOUNTAIN ST, SUITE D, KOKOMO, IN 46902-3802
(765) 453-3412
Mailing address
3415 S LAFOUNTAIN ST, SUITE D, KOKOMO, IN 46902-3802
(765) 453-3412
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007395A
IN
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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