Michael J. Wallace D.d.s.

NPI #1669519559 in Edmond, Oklahoma

Provider Information

NPI Number: 1669519559
Entity Type: Organization
Organization Name: Michael J. Wallace D.d.s.
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 31, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 1600 E 19TH ST
Address 2: SUITE 301
City: Edmond
State: Oklahoma
ZIP Code: 73013-6622
Phone: (405) 340-0411

Authorized Official

Name: DR. MICHAEL J WALLACE, D.D.S.
Title: DENTIST
Phone: (405) 340-0411

Specialties & Taxonomy Codes

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

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