DR. Stephen Anthony Wallace, D.D.S.

NPI #1780781831 in La Grange, Illinois

Provider Information

NPI Number: 1780781831
Entity Type: Individual
Name: DR. Stephen Anthony Wallace, D.D.S.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Credential: D.D.S.
Enumeration Date: Sep 20, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 310 W BURLINGTON AVE
City: La Grange
State: Illinois
ZIP Code: 60525-2363
Phone: (708) 352-2223

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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