Healthcare Provider Details

I. General information

NPI: 1710453063
Provider Name (Legal Business Name): WALLACH DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4529 EAST TX-71
DEL VALLE TX
78617
US

IV. Provider business mailing address

4529 EAST TX-71
DEL VALLE TX
78617
US

V. Phone/Fax

Practice location:
  • Phone: 903-216-9687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID BRIAN WALLACH
Title or Position: DENTIST
Credential: DDS
Phone: 903-216-9687