Individual
DR. TANNER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
73 LYME RD, SUITE 3, HANOVER, NH 03755-1207
(603) 643-3509
Mailing address
73 LYME RD, SUITE 3, HANOVER, NH 03755-1207
(603) 643-3509
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
04057
NH
Other
Enumeration date
06/25/2014
Last updated
11/07/2014
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