| D & A Wallace, Inc. | |
|
2003 E Quail Run Rd Emmett ID 83617-5059 | |
| (208) 365-3534 | |
| (208) 365-6231 |
| Full Name | D & A Wallace, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 2003 E Quail Run Rd, Emmett, Idaho |
| Authorized Official Name and Position | Andrea Layne Wallace (SECRETARY/OWNER) |
| Authorized Official Contact | 2083653534 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| D & A Wallace, Inc. 2003 E Quail Run Rd Emmett ID 83617-5059 Ph: (208) 365-3534 | D & A Wallace, Inc. 2003 E Quail Run Rd Emmett ID 83617-5059 Ph: (208) 365-3534 |
| NPI Number | 1144498437 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 02/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144498437 | NPI | - | NPPES |
| 8071026 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3656 (Idaho) | Primary |
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