Jane Sueko Wallace DDS

NPI 1073500922 - Dentist - 1223G0001X

NPI Details
NPI 1073500922
Gender Female
Enumeration Date 10/05/2005
Last Updated 02/25/2008
Entity Type Individual
Active Over 11 years ago
Practice Location
606 FISHER ST
81ST DS/SGD
KEESLER AFB MS, 39534-2513, US
Phone (228) 376-0511
Fax (228) 376-0193
Business Location
606 FISHER ST
81ST DS/SGD
KEESLER AFB MS, 39534-2513, US
Phone (228) 376-0511
Fax (228) 376-0193
Toxanomy
Taxonomy Code 1223G0001X
License State Missouri
License Number 015337
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According to our database, Dr. Jane Sueko Wallace DDS NPI is 1073500922, taxonomy code is 1223G0001X and license number is 015337, license state is located at Missouri. Jane Sueko Wallace DDS physically located at 606 Fisher St, Keesler Afb MS, 39534-2513. NPI Number Jane Sueko Wallace DDS has the Individual type.

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1073500922 NPI number is provided on an as is basis without warranty of any kind. 1073500922 is maintained by the National Plan & Provider Enumeration System. The contents of Jane Sueko Wallace DDS are for informational purposes only.