Michael J Wallace DDS

NPI 1417014424 - Dentist - 122300000X

NPI Details
NPI 1417014424
Gender Male
Enumeration Date 01/02/2007
Last Updated 07/09/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
1600 E 19TH ST
SUITE 301
EDMOND OK, 73013-6622, US
Phone (405) 340-0411
Fax (405) 340-3217
Business Location
1600 E 19TH ST
SUITE 301
EDMOND OK, 73013-6622, US
Phone (405) 340-0411
Fax (405) 340-3217
Toxanomy
Taxonomy Code 122300000X
License State Oklahoma
License Number 5801
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According to our database, Dr. Michael J Wallace DDS NPI is 1417014424, taxonomy code is 122300000X and license number is 5801, license state is located at Oklahoma. Michael J Wallace DDS physically located at 1600 E 19th St, Edmond OK, 73013-6622. NPI Number Michael J Wallace DDS has the Individual type.

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1417014424 NPI number is provided on an as is basis without warranty of any kind. 1417014424 is maintained by the National Plan & Provider Enumeration System. The contents of Michael J Wallace DDS are for informational purposes only.