Deanna T Wallace
Dental Hygienist
1344 Creston Park Dr Ste 2
Janesville
, Wisconsin 53545-1113
Deanna T Wallace
Dental Hygienist
1344 Creston Park Dr Ste 2
Janesville
, Wisconsin 53545-1113
(608) 314-1930
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About
Features
Specialties
- Dental Hygienist
Languages spoken
- English
Location
First Address
- Deanna T Wallace
- 23 W Milwaukee St
- Janesville, WI
- Zip : 53548-2981
- Phone : (608) 314-1930
Second Address
- Deanna T Wallace
- 1344 Creston Park Dr Ste 2
- Janesville, WI
- Zip : 53545-1113
- Phone : (608) 314-1940
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | 5054-16 | WI |
National Provider Identifier
| NPI | 1043880438 |
|---|---|
| Provider Name | Deanna T Wallace |
| First Address | Janesville, WI 53548-2981 |
| Second Address | Janesville, WI 53545-1113 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 28/06/2021 |
| Last Update Date | 28/06/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.