Individual
DARREN K WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2003 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-3534
(208) 365-6231
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3641
ID
Other
Enumeration date
08/20/2006
Last updated
01/16/2014
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