Organization
THE WALLACE MEDICAL CONCERN
Active
Other names
Wallace
Organization subpart
No
Provider details
NPI number
Authorized official
STUART CURRIE MD, MMM (CMO)
(503) 489-1760
Entity
Organization
Contact information
Practice address
18139 NE COUCH STREET, PORTLAND, OR 97230
(503) 489-1760
Mailing address
18139 NE COUCH STREET, PORTLAND, OR 97230
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
124Q00000X
Dental Hygienist
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
03/30/2016
Last updated
02/24/2022
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