MRS. Andrea L Wallace, D.M.D.

NPI #1871608604 in Emmett, Idaho

Provider Information

NPI Number
1871608604
Entity Type
Individual
Name
MRS. Andrea L Wallace, D.M.D.
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Dentist - General Practice
Credential
D.M.D.
Enumeration Date
Aug 20, 2006
Last Updated
Jul 9, 2007

Practice Location

Address
2003 S PLAZA RD
City
Emmett
State
Idaho
ZIP Code
83617-9180
Phone
(208) 365-3534

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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