Individual
DR. MARSHALL LYNN WALLACE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3 PROFESSIONAL CT, SUMTER, SC 29150-1927
(803) 469-9461
(803) 469-9023
Mailing address
3 PROFESSIONAL CT, SUMTER, SC 29150-1927
(803) 469-9461
(803) 469-9023
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
2839/363
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9760
—
SC
Enumeration date
02/14/2006
Last updated
07/08/2007
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