Individual
DR. JOHN HENRY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
583 MOULL ST, NEWARK, OH 43055-2909
(740) 366-1988
(740) 364-0774
Mailing address
583 MOULL ST, NEWARK, OH 43055-2909
(740) 366-1988
(740) 364-0774
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
16606
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0434800
—
OH
Enumeration date
08/15/2006
Last updated
07/08/2007
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