Mark Charles Wallace, Dds, PC
NPI #1184046385 in Minneapolis, Minnesota
Provider Information
- NPI Number
- 1184046385
- Entity Type
- Organization
- Organization Name
- Mark Charles Wallace, Dds, PC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Jan 8, 2014
- Last Updated
- Jan 8, 2014
Practice Location
- Address
- 3909 SILVER LAKE RD NE
- City
- Minneapolis
- State
- Minnesota
- ZIP Code
- 55421-4352
- Phone
- (612) 789-3573
Authorized Official
- Name
- REBECCA M KIPP
- Title
- OFFICE MANAGER
- Phone
- (612) 789-3573
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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