Individual
DR. MARTHA COCHRAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
1400 6TH AVE S, BIRMINGHAM, AL 35233-1502
(205) 930-1015
(205) 930-1448
Mailing address
1400 6TH AVE S, BIRMINGHAM, AL 35233-1502
(205) 930-1015
(205) 930-1448
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3030
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103546
—
AL
05
—
103578
—
AL
05
—
103676
—
AL
05
—
103678
—
AL
05
—
1639172158
—
AL
01
—
510-40457
BLUE CROSS BLUE SHIELD
AL
01
—
510-40458
BLUE CROSS BLUE SHIELD
AL
01
—
510-40459
BLUE CROSS BLUE SHIELD
AL
01
—
510-40460
BLUE CROSS BLUE SHIELD
AL
Enumeration date
05/30/2005
Last updated
01/05/2011
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