Individual
JACOB ROBERT WALLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
145 S MARR ST, FOND DU LAC, WI 54935-4408
(920) 922-9000
Mailing address
1801 W WISCONSIN AVE, MILWAUKEE, WI 53233-2186
(414) 322-9456
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002568-15
WI
Other
Enumeration date
04/07/2021
Last updated
06/17/2021
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