Individual
C.M. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8951 BONITA BEACH RD SE STE 206, BONITA SPRINGS, FL 34135-4202
(239) 992-8555
(239) 992-8644
Mailing address
8951 BONITA BEACH RD SE STE 206, BONITA SPRINGS, FL 34135-4202
(239) 992-8555
(239) 992-8644
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN14024
FL
Other
Enumeration date
12/06/2013
Last updated
12/06/2013
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