Kevin Reilly Wallace DMD

NPI 1053423285 - Dentist - 122300000X

NPI Details
NPI 1053423285
Gender Male
Enumeration Date 09/01/2006
Last Updated 03/26/2016
Entity Type Individual
Active Over 10 years ago
Practice Location
5549 S CORNELL AVE
CHICAGO IL, 60637-1914, US
Phone (773) 716-3697
Fax
Business Location
5549 S CORNELL AVE
CHICAGO IL, 60637-1914, US
Phone (773) 716-3697
Fax
Toxanomy
Taxonomy Code 122300000X
License State New York
License Number 53731-1
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According to our database, Dr. Kevin Reilly Wallace DMD NPI is 1053423285, taxonomy code is 122300000X and license number is 53731-1, license state is located at New York. Kevin Reilly Wallace DMD physically located at 5549 S Cornell Ave, Chicago IL, 60637-1914. NPI Number Kevin Reilly Wallace DMD has the Individual type.

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1053423285 NPI number is provided on an as is basis without warranty of any kind. 1053423285 is maintained by the National Plan & Provider Enumeration System. The contents of Kevin Reilly Wallace DMD are for informational purposes only.