Provider Information for 1275566101
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WALLACE DENT GITCHEL MHPP
Sex: Male
NPI: 1275566101
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1275566101 | ||||||||
| Enumeration Date | 2006-07-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 6430 SPRINGDALE, AR 72766-6430 United States Phone: 479-750-2020 | Fax:479-750-1739 | ||||||||
| Primary Practice Address | 2400 S 48TH ST SPRINGDALE, AR 72762-6683 United States Phone: 479-750-2020 | Fax:479-750-1739 | ||||||||
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