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 |