Individual
OSCAR RUSSELL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
312 TRIBBLE GAP RD, CUMMING, GA 30040-2440
(770) 887-1399
Mailing address
2545 PINE BLUFF DR, DECATUR, GA 30033-4927
(404) 723-0281
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN123883
GA
Other
Enumeration date
04/09/2025
Last updated
09/17/2025
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