DR. Brian Wallace, DMD
NPI #1093866121 in Prestonsburg, Kentucky
Provider Information
- NPI Number
- 1093866121
- Entity Type
- Individual
- Name
- DR. Brian Wallace, DMD
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Dentist - General Practice
- Credential
- DMD
- Enumeration Date
- Jan 16, 2007
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 781 S LAKE DR
- Address 2
- SUITE 1
- City
- Prestonsburg
- State
- Kentucky
- ZIP Code
- 41653-1340
- Phone
- (606) 886-2676
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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