Provider Demographics
NPI:1255228508
Name:WALLACE, ALAINA CHRISTINE (DDS)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:CHRISTINE
Last Name:WALLACE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 JERSEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2293
Mailing Address - Country:US
Mailing Address - Phone:563-359-5510
Mailing Address - Fax:563-359-3051
Practice Address - Street 1:3475 JERSEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2293
Practice Address - Country:US
Practice Address - Phone:563-359-5510
Practice Address - Fax:563-359-3051
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist