MRS. ANDREA L WALLACE (NPI# 1871608604) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871608604 |
| Entity Type | Individual |
| Full Name | MRS. ANDREA L WALLACE |
| Credential | D.M.D. |
| Practice Address |
2003 S Plaza Rd Emmett ID 83617-9180 |
| Practice Telephone | 2083653534 |
| Practice Fax Number | 2083656231 |
| Mailing Telephone | 2083653534 |
| Mailing Fax Number | 2083656231 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D-3656 | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 8071026 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154976777 | Andrea Shanwtrae Wallace | Contractor | 2130 N Arrowhead Ave Ste 205b-1c, San Bernardino, CA 92405-4029 | 2019-08-09 |
| 1083264485 | Andrea Namon Wallace | Student in an Organized Health Care Education/Training Program | 9808 Venice Blvd Ste 700, Culver City, CA 90232-6824 | 2019-09-17 |
| 1417455809 | Andrea Wallace | Nurse Practitioner | 7810 Providence Rd, Ste 102, Charlotte, NC 28226-2954 | 2018-01-31 |
| 1902116122 | Andrea Wallace | Physical Therapist | 1231 Pine Grove Ave, Suite 1a, Port Huron, MI 48060-3500 | 2010-10-21 |
| 1326166315 | Andrea Yvonne Wallace | Physical Therapy Assistant | 3 Merit Dr, Richmond Heights, OH 44143-1457 | 2007-03-27 |
| 1396819884 | Andrea Lynn Wallace | Audiologist | 7373 West Ln, Stockton, CA 95210-3377 | 2006-11-17 |
| 1669491171 | Andrea S Wallace | Internal Medicine | 101 Manning Dr, Chapel Hill, NC 27599-0001 | 2006-07-18 |
| Street Address |
2003 S PLAZA RD |
| City | EMMETT |
| State | ID |
| Zip Code | 83617-9180 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245425198 | Jimmy Joe Zarybnisky | Dentist | 2003 S Plaza Rd, Emmett, ID 83617-9180 | 2007-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699375659 | Jonathan Barrus Do PC | Family Medicine | 2020 S Johns Avenue, Emmett, ID 83617 | 2020-10-29 |
| 1679039135 | Hollis Family Pharmacy LLC | Pharmacy | 845 S Substation Rd, Emmett, ID 83617 | 2019-02-20 |
| 1699248054 | Lisa Southard | Social Worker | 825 S. Washington Avenue, Emmett, ID 83617 | 2019-01-09 |
| 1396069712 | Kelsey Peterson | Dentist | 1312 South Washington Street, Emmett, ID 83617 | 2010-03-15 |
| 1598907073 | Bimart Corporation | Durable Medical Equipment & Medical Supplies | 179 West Highway 52, Emmett, ID 83617 | 2009-03-31 |
| 1548401169 | Cynthia K. Rokey | Massage Therapist | 3777 S. Johns Ave, Emmett, ID 83617 | 2009-03-11 |
| 1407984966 | Jill Janay Sprague | Counselor | 113 N Commercial, Emmett, ID 83617 | 2007-02-28 |
| 1548320252 | Jo Anna Henson1 | Homemaker | 2020 Ua Ave Sp 14, Emmett, ID 83617 | 2006-12-11 |
| 1922193200 | Nancy Susanne Nickerson | Physical Therapist | 809 S Washington, Emmett, ID 83617 | 2006-10-04 |
| 1083707277 | Michael S Lee | Social Worker | 2007 S Plaza, Suite #1, Emmett, ID 83617 | 2006-10-02 |
| Find all providers in zip 83617 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396069712 | Kelsey Peterson | Dentist | 1312 South Washington Street, Emmett, ID 83617 | 2010-03-15 |
| 1841305646 | Darren K Wallace | Dentist | 2003 E Quail Run Rd, Emmett, ID 83617-5059 | 2006-08-20 |
| 1699051250 | Elkins Dentistry, Pllc | Dentist | 1110 S Washington Ave, Emmett, ID 83617-3535 | 2011-10-27 |
| 1255577490 | Warren Willis Dmd P.C. | Dentist | 119 N Wardwell Ave, Emmett, ID 83617-3040 | 2008-12-17 |
| 1679732804 | Black Canyon Dental P C | Dentist | 1110 S Washington Ave, Emmett, ID 83617-3535 | 2008-06-03 |
| 1568535011 | Warren Richard Willis | Dentist | 119 N Wardwell Ave, Emmett, ID 83617-3040 | 2006-11-15 |
| 1376592337 | Shon Dewane Rooks | Dentist | 1110 S Washington Ave, Emmett, ID 83617-3535 | 2006-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891304556 | Birchwood Dental, Pllc | Dentist | 3325 N Ten Mile Rd Ste 140, Meridian, ID 83646-6951 | 2020-07-29 |
| 1588273635 | Atlantis Dental Care, P.a. | Dentist | 13238 W Persimmon Ln Ste 100, Boise, ID 83713-1968 | 2020-07-24 |
| 1235747338 | Dentists of Boise and Orthodontics, PC | Dentist | 7500 W State St Ste 110, Boise, ID 83714-6074 | 2020-07-15 |
| 1346895232 | Tejasi Avasare | Dentist | 8321 W Overland Rd, Boise, ID 83709-1640 | 2019-08-07 |
| 1740835248 | Braden Comstock | Dentist | 2329 N Merritt Creek Loop, Coeur D Alene, ID 83814-4950 | 2019-08-02 |
| 1902450430 | Jaren M Thueson | Dentist | 106 E 1st N, Rexburg, ID 83440-1614 | 2019-08-01 |
| 1528610359 | Melissa Marie Pysnak | Dentist | 8850 W Emerald St Ste 150, Boise, ID 83704-4809 | 2019-07-11 |
| 1811555758 | Daniel Whitesitt | Dentist | 14596 Id-41, Rathdrum, ID 83858 | 2019-06-05 |
| 1104483122 | Meghan Cyrena Bristlin | Dentist | 3326 4th St Ste 3, Lewiston, ID 83501-4455 | 2019-05-24 |
| 1124684584 | Trevor Tafoya Dds Victory Dental, Pllc | Dentist | 7421 W Victory Rd, Boise, ID 83709-5106 | 2019-05-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.