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Organization
THE WALLACE MEDICAL CONCERN
Active
Organization
THE WALLACE MEDICAL CONCERN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE SIRIANNI (EA & FEDERAL GRANTS PROGRAM MANAGER)
(503) 489-1760
Entity
Organization
Contact information
Practice address
18633 SE STARK ST STE 401, PORTLAND, OR 97233-5468
(503) 489-1760
Mailing address
18633 SE STARK ST STE 401, PORTLAND, OR 97233-5468
(503) 489-1760
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/01/2021
Last updated
03/23/2026
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