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Organization
WALLACE FAMILY DENTISTRY LLC
Active
Organization
WALLACE FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED R GRAHAM DDS (MANAGING MEMBER)
(513) 531-2338
Entity
Organization
Contact information
Practice address
5258 MONTGOMERY RD, CINCINNATI, OH 45212-1648
(513) 531-2338
(513) 841-5545
Mailing address
5258 MONTGOMERY RD, CINCINNATI, OH 45212-1648
(513) 531-2338
(513) 841-5545
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
12/02/2025
Last updated
09/14/2026
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