Davis-Wallace, Dedra Desiree
Davis-Wallace, Dedra Desiree is an sole proprietor health care provider with primary practice located at 3131 Stein Blvd , Eau Claire WI 54701-6978. She recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as her primary health care specialty. Davis-Wallace, Dedra Desiree can be contacted via phone (715) 835-7172.Contact Information
Primary practice address
3131 Stein Blvd
Eau Claire WI 54701-6978
Phone: (715) 835-7172
Fax: (713) 490-6464
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | DN012272 | Georgia |
| Dental Providers / Pediatric Dentistry | 1223P0221X | 24891 | Texas |
| Dental Providers / Pediatric Dentistry | 1223P0221X | 1001197-15 | Wisconsin |
Profile Details
| NPI number | 1518057934 |
|---|---|
| LBN Legal business name | Davis-Wallace, Dedra Desiree |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 14th, 2006 |
| Last updated | Jul 12th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518057934 | NPPES |
| Wisconsin | MEDICAID | 1518057934 |
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