Provider Demographics
NPI:1538137278
Name:SERPAS, WALLACE G III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:G
Last Name:SERPAS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 PERDIDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1026
Mailing Address - Country:US
Mailing Address - Phone:504-525-9990
Mailing Address - Fax:504-525-9050
Practice Address - Street 1:818 PERDIDO ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1026
Practice Address - Country:US
Practice Address - Phone:504-525-9990
Practice Address - Fax:504-525-9050
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist