Individual
DR. JOHN DAVID WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
8315 WALNUT HILL LN STE 120, DALLAS, TX 75231-4218
(214) 363-9946
(214) 389-1953
Mailing address
8315 WALNUT HILL LN STE 120, DALLAS, TX 75231-4218
(214) 363-9946
(214) 389-1953
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
19862
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750242-02
—
TX
Enumeration date
11/10/2005
Last updated
06/16/2023
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