MS. Marquita Diane Wallace
MS. Marquita Diane Wallace is a Dentist in Covington, Louisiana. Licensed in Louisiana. Registered with an NPI since 2010.
- Licensed in
- LA
- In the registry since
- 2010
Practice location Address checks out
600 N Highway 190 Ste 4Covington, LA 70433-5003
Phone: (615) 887-1379
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Dentist (primary) | Taxonomy 122300000X · Licence 6135 (LA) |
|---|
Record details
| NPI number | 1598087900 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | No |
| NPI enumerated | February 26, 2010 |
| Last updated in NPPES | September 25, 2013 |
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