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Dr. Joni K Wallace

Dentist, General Practice in Austin, TX. Individual provider (NPI-1).

NPI number1487871968
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1487871968
Entity type
Individual (NPI-1)
Name
Dr. Joni K Wallace
Sex
Female
Sole proprietor
Yes
Enumeration date
Apr 19, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice18163TXYes

Practice location

2414 Exposition Blvd
Suite B-105
Austin, TX 78703

Phone 512-236-1611 · Fax 512-236-0767

Mailing address

2414 Exposition Blvd
Suite B-105
Austin, TX 78703

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