Individual provider · Type 1 NPI

Jeffrey Robert Wallace, D.D.S

Student in an Organized Health Care Education/Training Program · Atlanta, GA

NPI number 1306006796 Active

Practice location

1365 Clifton Rd NE, Building B Suite 2300
Atlanta, GA 30322-1013

Call (404) 778-4500 Map

Mailing address

44 Peachtree Pl NW, Unit 722
Atlanta, GA 30309-5408

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1306006796

Jeffrey Robert Wallace, D.D.S's National Provider Identifier is 1306006796, issued on Jun 10, 2008. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Atlanta, GA. The record was last updated on Jun 10, 2008.