MRS. Tabitha A Wallace, RDH

NPI #1629348198 in Little Rock, Arkansas

Provider Information

NPI Number: 1629348198
Entity Type: Individual
Name: MRS. Tabitha A Wallace, RDH
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dental Hygienist
Credential: RDH
Enumeration Date: Dec 30, 2011
Last Updated: Dec 30, 2011

Practice Location

Address: 12921 CANTRELL ROAD
Address 2: SUITE 101
City: Little Rock
State: Arkansas
ZIP Code: 72223-1798
Phone: (501) 664-3279

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dental Hygienist	124Q00000X	Primary

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