Individual
DR. MICHAEL JAMES WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1195 W MASON ST, GREEN BAY, WI 54303-2045
(920) 498-3633
(920) 498-1099
Mailing address
1195 W MASON ST, GREEN BAY, WI 54303-2045
(920) 498-3633
(920) 498-1099
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2515
WI
Other
Enumeration date
09/22/2006
Last updated
07/08/2007
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