Individual
DR. DOUGLAS W. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
5188 WINTON RD, FAIRFIELD, OH 45014-2900
(513) 829-8080
(513) 858-4290
Mailing address
5188 WINTON RD, FAIRFIELD, OH 45014-2900
(513) 829-8080
(513) 858-4290
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
30-01-6806
OH
Other
Enumeration date
01/24/2007
Last updated
04/01/2008
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