Provider Demographics
NPI:1861667958
Name:WALLET, KAREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:WALLET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2309
Mailing Address - Country:US
Mailing Address - Phone:856-983-4349
Mailing Address - Fax:856-985-6366
Practice Address - Street 1:925 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2309
Practice Address - Country:US
Practice Address - Phone:856-983-4349
Practice Address - Fax:856-985-6366
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01831300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist