Michael J. Wallace D.D.S. Valid NPI
Organization · General Practice Dentistry · Edmond, OK
- NPI
- 1669519559
- Type
- Organization (Type 2)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 5801 (OK)
- Enumerated
- 2007-01-31
- Last updated
- 2020-08-22
Practice location
1600 E 19th St, Suite 301
Edmond, OK 73013-6622
(405) 340-0411