| NPI | 1437622503 |
|---|---|
| Doing Business As | JARED WALLIS DDS |
| Entity Type | Organization |
| Authorized Contact | JARED WALLIS Dentist/Owner 575-521-9375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2019-01-10 |