Organization
MICHAEL J. WALLACE D.D.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J WALLACE D.D.S. (DENTIST)
(405) 340-0411
Entity
Organization
Contact information
Practice address
1600 E 19TH ST, SUITE 301, EDMOND, OK 73013-6622
(405) 340-0411
(405) 340-3217
Mailing address
1600 E 19TH ST, SUITE 301, EDMOND, OK 73013-6622
(405) 340-0411
(405) 340-3217
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5801
OK
Other
Enumeration date
01/31/2007
Last updated
08/22/2020
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