Individual
HEATH R WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13160 MAIN STREET, WESTON, OH 43569
(419) 669-2839
Mailing address
13160 MAIN STREET, WESTON, OH 43569
(419) 669-2839
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30-022208
OH
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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