Organization
PHILLIP W WALLACE DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP W WALLACE DDS (OWNER)
(440) 946-5484
Entity
Organization
Contact information
Practice address
36001 EUCLID AVE, SUITE A-15, WILLOUGHBY, OH 44094-4643
(440) 946-5485
(440) 946-5810
Mailing address
36001 EUCLID AVE, SUITE A-15, WILLOUGHBY, OH 44094-4643
(440) 946-5485
(440) 946-5810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30.016266
OH
Other
Enumeration date
12/08/2015
Last updated
12/08/2015
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