Individual
DR. BEN JAMES WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
110 E 79TH ST, CHICAGO, IL 60619-2302
(773) 488-6000
Mailing address
225 MORAY CT, CRETE, IL 60417-1127
(708) 757-3963
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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