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1306006796
JEFFREY ROBERT WALLACE
ATLANTA, GA
NPI
1306006796
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2008-06-10
Last Update Date
2008-06-10
Business Address
Dr. JEFFREY ROBERT WALLACE D.D.S
1365 CLIFTON RD NE BUILDING B SUITE 2300
ATLANTA, GA 30322-1013
Phone number: 404-778-4500
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Mailing Address
Dr. JEFFREY ROBERT WALLACE D.D.S
44 PEACHTREE PL NW UNIT 722
ATLANTA, GA 30309-5408
Phone number: 404-840-4945
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