DR. Kevin R Wallace, DMD

NPI #1053423285 in Chicago, Illinois

Provider Information

NPI Number: 1053423285
Entity Type: Individual
Name: DR. Kevin R Wallace, DMD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: DMD
Enumeration Date: Sep 1, 2006
Last Updated: Jan 19, 2021

Practice Location

Address: 150 E HURON ST
Address 2: STE 1103
City: Chicago
State: Illinois
ZIP Code: 60611
Phone: (312) 676-9893

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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