Organization
MARK CHARLES WALLACE, DDS, PC
Active
Other names
Advanced Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA M KIPP (OFFICE MANAGER)
(612) 789-3573
Entity
Organization
Contact information
Practice address
3909 SILVER LAKE RD NE, MINNEAPOLIS, MN 55421-4352
(612) 789-3573
Mailing address
3909 SILVER LAKE RD NE, MINNEAPOLIS, MN 55421-4352
(612) 789-3573
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/08/2014
Last updated
01/08/2014
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