Individual
DR. MARK C WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
50 COUNTY ROAD B E, SAINT PAUL, MN 55117-1927
(651) 488-2541
(651) 488-8944
Mailing address
6642 PICHA PL, EDEN PRAIRIE, MN 55346-2508
(952) 500-9805
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5919
WA
1223G0001X
General Practice Dentistry
Primary
D12888
MN
Other
Enumeration date
05/01/2007
Last updated
06/25/2012
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