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DR. DEDRA DESIREE DAVIS-WALLACE DDS
NPI 1518057934
Dentist - Pediatric Dentistry in Eau Claire, WI

Active since October 14, 2006
3131 STEIN BLVD, EAU CLAIRE, WI 54701(715) 835-7172(713) 490-6464 Get Directions Write a Review

NPPES record last updated: July 12, 2022. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Dr. Dedra Desiree Davis-wallace Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DEDRA DESIREE DAVIS-WALLACE DDS (NPI 1518057934) is an individual pediatric dentistry provider in Eau Claire, Wisconsin, licensed in Wisconsin (1001197-15) and active in the NPI registry since October 2006.

NPPES Registry Identity

NPI1518057934
Entity TypeIndividualFemale
Primary Taxonomy1223P0221X
Provider Legal NameDR. DEDRA DESIREE DAVIS-WALLACECredential: DDS
Location Address3131 STEIN BLVDEau Claire, WI 54701-6978
Mailing Address3131 Stein BlvdEau Claire, WI 54701-6978 · (715) 835-7172
Phone(715) 835-7172
Fax(713) 490-6464
Sole ProprietorYes
Enumeration DateOctober 14, 2006
Last NPPES UpdateJuly 12, 2022
NPPES CertifiedJuly 12, 2022
✔ NPI 1518057934 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers
Taxonomy Code1223P0221X
Licenses✔ Licensed in WI · 1001197-15✔ Licensed in GA · DN012272✔ Licensed in TX · 24891
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
3131 STEIN BLVD, Eau Claire, WI 54701
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Other Identifiers 1

Medicaid1518057934WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNA SWENSON DNP, FNP-BC, AANP
Nurse Practitioner (Family)
3131 STEIN BLVD
EAU CLAIRE, WI 54701
Eau Claire County (715) 830-0732
DR. WILLIAM D BETHKE DDS
Dentist (General Practice)
3131 STEIN BLVD
EAU CLAIRE, WI 54701
Eau Claire County (715) 835-7172
NICHOLE ANN MARTY FNP-BC
Nurse Practitioner (Family)
3131 STEIN BLVD
EAU CLAIRE, WI 54701
Eau Claire County (715) 830-0732
NEAL R. BENHAM D.D.S.,S.C.
Dentist (Pediatric Dentistry)
3131 STEIN BLVD
EAU CLAIRE, WI 54701
Eau Claire County (715) 835-7172
DR. NEAL R BENHAM DDS
Dentist (Pediatric Dentistry)
3131 STEIN BLVD
EAU CLAIRE, WI 54701
Eau Claire County (715) 835-7172
ALL FAMILY DENTAL, LLC
Dentist
3131 STEIN BLVD
EAU CLAIRE, WI 54701
Eau Claire County (715) 835-7172
KYLE RAYMOND RONQUIST DDS
Dentist
3131 STEIN BLVD
EAU CLAIRE, WI 54701
Eau Claire County (715) 835-7172

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dedra Davis-wallace's NPI number?

The NPI number for Dedra Davis-wallace is 1518057934. It was assigned to this individual provider in the NPPES registry on October 14, 2006.

Where is Dedra Davis-wallace located?

Dedra Davis-wallace practices at 3131 Stein Blvd, Eau Claire, WI 54701. The listed phone number is (715) 835-7172.

What is Dedra Davis-wallace's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

What insurance does Dedra Davis-wallace accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Delta Dental of Wisconsin, Inc. and 1 other insurer list Dedra Davis-wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Dedra Davis-wallace was last updated on July 12, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.