Individual
DR. CHARLES WAYNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
502 N COALTER ST, STAUNTON, VA 24401-3401
(540) 885-3060
Mailing address
502 N COALTER ST, STAUNTON, VA 24401-3401
(540) 885-3060
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401003798
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401003798
DENTAL LICENSE
VA
01
—
B23831643
DRIVER'S LICENSE
VA
Enumeration date
03/07/2007
Last updated
03/07/2023
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