Dr Dedra Desiree Davis-wallace, DDS - Dentist in Eau Claire, WI

Dr Dedra Desiree Davis-wallace, DDS is a Dentist - Pediatric Dentistry based in Eau Claire, Wisconsin. Dr Dedra Desiree Davis-wallace is licensed to practice in Wisconsin (license number 1001197-15) and her current practice location is 3131 Stein Blvd, Eau Claire, Wisconsin. She can be reached at her office (for appointments etc.) via phone at (715) 835-7172.

NPI number for Dr Dedra Desiree Davis-wallace is 1518057934 and her current mailing address is 3131 Stein Blvd, Eau Claire, Wisconsin. She does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1518057934.

Contact Information

Dr Dedra Desiree Davis-wallace, DDS
3131 Stein Blvd,
Eau Claire, WI 54701-6978
(715) 835-7172
(713) 490-6464

Map and Direction




Healthcare Provider's Profile

Full NameDr Dedra Desiree Davis-wallace
GenderFemale
SpecialityDentist - Pediatric Dentistry
Location3131 Stein Blvd, Eau Claire, Wisconsin
Accepts Medicare AssignmentsDoes not participate in Medicare Program. She may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1518057934
  • Provider Enumeration Date: 10/14/2006
  • Last Update Date: 07/12/2022

Medical Identifiers

Medical identifiers for Dr Dedra Desiree Davis-wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1518057934NPI-NPPES
1518057934MedicaidWI

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
1223P0221XDentist - Pediatric Dentistry DN012272 (Georgia)Secondary
1223P0221XDentist - Pediatric Dentistry 24891 (Texas)Secondary
1223P0221XDentist - Pediatric Dentistry 1001197-15 (Wisconsin)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Dedra Desiree Davis-wallace is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Dedra Desiree Davis-wallace, DDS
3131 Stein Blvd,
Eau Claire, WI 54701-6978

Ph: (715) 835-7172
Dr Dedra Desiree Davis-wallace, DDS
3131 Stein Blvd,
Eau Claire, WI 54701-6978

Ph: (715) 835-7172

Reviews and Comments


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