Individual
DR. KEVIN BRUCE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
949 N 14TH ST, LEESBURG, FL 34748-3838
(352) 816-0855
Mailing address
1107 S.E. 24 TERRACE, OCALA, FL 34471
(352) 867-9890
(352) 622-7616
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN15774
FL
Other
Enumeration date
07/25/2006
Last updated
11/02/2011
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