Individual
DR. MARK SPANGLER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
168 N 1950 W STE 202, SALT LAKE CITY, UT 84116-3007
(801) 715-3400
Mailing address
168 N 1950 W STE 202, SALT LAKE CITY, UT 84116-3007
(801) 715-3400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
142818-9921
UT
Other
Enumeration date
09/20/2005
Last updated
04/06/2020
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