Organization
MICHAEL P. WALLACE D.M.D., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL PATRICK WALLACE D.M.D. (OWNER)
(314) 968-0003
Entity
Organization
Contact information
Practice address
9225 MANCHESTER RD, SUITE 101, SAINT LOUIS, MO 63144-2640
(314) 968-0003
(314) 968-0383
Mailing address
9225 MANCHESTER RD, SUITE 101, SAINT LOUIS, MO 63144-2640
(314) 968-0003
(314) 968-0383
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13992
MO
Other
Enumeration date
01/08/2009
Last updated
01/08/2009
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