Heath R Wallace

NPI #1811010069 in Weston, Ohio

Provider Information

NPI Number: 1811010069
Entity Type: Individual
Name: Heath R Wallace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Enumeration Date: Apr 10, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 13160 MAIN STREET
City: Weston
State: Ohio
ZIP Code: 43569
Phone: (419) 669-2839

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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