D & a Wallace, Inc.

NPI #1144498437 in Emmett, Idaho

Provider Information

NPI Number: 1144498437
Entity Type: Organization
Organization Name: D & a Wallace, Inc.
Primary Specialty: Dentist
Enumeration Date: Feb 20, 2008
Last Updated: Feb 20, 2008

Practice Location

Address: 2003 E QUAIL RUN RD
City: Emmett
State: Idaho
ZIP Code: 83617-5059
Phone: (208) 365-3534

Authorized Official

Name: MRS. ANDREA LAYNE WALLACE, D.M.D.
Title: SECRETARY/OWNER
Phone: (208) 365-3534

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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