Individual
DR. DUSTIN GUY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2801 S OLIVE ST, PINE BLUFF, AR 71603-5433
(870) 663-4180
Mailing address
1165 ARROWHEAD RD, PINE BLUFF, AR 71603-9443
(870) 543-0529
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
32331
TX
1223G0001X
General Practice Dentistry
Primary
4095
AR
Other
Enumeration date
06/09/2016
Last updated
03/20/2018
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