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Dr. Dedra Desiree Davis-wallace, DDS
Pediatric Dentist in Eau Claire, Wisconsin
NPI 1518057934

Dedra Desiree Davis-wallace is a Pediatric Dentist based in Eau Claire, WI and is specialized in Pediatric Dentistry. Dedra Desiree Davis-wallace practices in Eau Claire, WI and has the professional credentials of DDS. The NPI Number for Dedra Desiree Davis-wallace is 1518057934 and holds a License No. DN012272 (Wisconsin).

The current practice location address for Dedra Desiree Davis-wallace is 3131 Stein Blvd, Eau Claire, WI and can be reached out via phone at 715-835-7172 and via fax at 713-490-6464.

Location: 3131 Stein Blvd, Eau Claire, WI, 54701-6978
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1518057934
Provider Name
Dedra Desiree Davis-wallace
Credential
DDS
Provider Entity Type
Individual
Gender
Female
Address
3131 Stein Blvd, Eau Claire, WI, 54701-6978
Phone Number
715-835-7172
Fax Number
713-490-6464
Provider Enumeration Date
10/14/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1518057934 05 WI
institution
Provider Business Practice Location Address Details
Address
3131 Stein Blvd
City
Eau Claire
State
Wisconsin
Zip
54701-6978
Phone Number
715-835-7172
Fax Number
713-490-6464
person
Provider Business Mailing Address Details
Address
3131 Stein Blvd
City
Eau Claire
State
Wisconsin
Zip
54701-6978
Phone Number
715-835-7172
Fax Number
713-490-6464
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
DN012272 (Georgia)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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