NPI 1023496148

Joel Richard Wallace, DDS

Practitioner General Practice Dentistry Eagle River, AK

Practice location

Address: 16727 Farm Avenue, Eagle River, AK 99577
Phone: (907) 694-4032

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 519 (AK)

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Registry record

NPI: 1023496148
Entity type: Individual
Sex (as registered): Male
NPI issued: 8 May 2015
Record last updated: 8 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.