Wallace, Andrea L
Wallace, Andrea L is an individual health care provider with primary practice located at 2003 S Plaza Rd , Emmett ID 83617-9180. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Wallace, Andrea L can be contacted via phone (208) 365-3534.Contact Information
Primary practice address
2003 S Plaza Rd
Emmett ID 83617-9180
Phone: (208) 365-3534
Fax: (208) 365-6231
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | D-3656 | Idaho |
Profile Details
| NPI number | 1871608604 |
|---|---|
| LBN Legal business name | Wallace, Andrea L |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 20th, 2006 |
| Last updated | Jul 9th, 2007 - about 19 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 | 1871608604 | NPPES |
| Idaho | MEDICAID | 8071026 |
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