Jason Wallace, D.D.S. Valid NPI
Individual provider · General Practice Dentistry · Edmond, OK
- NPI
- 1346698842
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 6806 (OK)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2016-05-25
- Last updated
- 2016-05-25
Practice location
1400 W Covell Rd
Edmond, OK 73003-3504
(405) 348-6161