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General NPI Number Information
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NPI Number | 1811148638
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Entity Type | Organization
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Legal Business Name | ERIC H. WALLACE D.D.S P.A.
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 28 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-391-0020
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Fax | 561-391-8863
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Provider Business Mailing Address
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Address Line | 28 SE 6TH ST
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City | BOCA RATON
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State | FL
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Zip | 33432-6016
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Country | US
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Telephone | 561-391-0020
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Fax | 561-391-8863
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC H WALLACE
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Credential | DDS
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Telephone | 561-391-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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