Stephen Wallace DDS INC

NPI #1902059678 in La Grange, Illinois

Provider Information

NPI Number: 1902059678
Entity Type: Organization
Organization Name: Stephen Wallace DDS INC
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 28, 2008
Last Updated: Oct 28, 2008

Practice Location

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

Authorized Official

Name: DR. STEPHEN WALLACE, DDS
Title: PRESIDENT
Phone: (708) 352-2223

Specialties & Taxonomy Codes

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

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