# KENNETH F. WALLACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952561375
- **Authorized official:** DR. KENNETH FRANKLIN WALLACE DMD (DENTIST)
- **Authorized official phone:** (859) 283-1986

## Contact information

- **Practice address:** 280 MOUNT ZION RD, SUITE D, FLORENCE, KY 41042-3217
- **Practice address phone:** (859) 283-1986
- **Practice address fax:** (859) 283-2586
- **Mailing address:** 280 MOUNT ZION RD, SUITE D, FLORENCE, KY 41042-3217
- **Mailing address phone:** (859) 283-1986
- **Mailing address fax:** (859) 283-2586

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 6386 | KY | Yes |

## Other

- **Enumeration date:** 06/10/2008
- **Last updated:** 06/10/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 60063864 | — | KY |