Organization
BENJAMIN C. WALLACE DDS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN WALLACE DDS (OWNER)
(616) 724-7824
Entity
Organization
Contact information
Practice address
1330 W WASHINGTON ST, GREENVILLE, MI 48838-2190
(616) 754-7414
Mailing address
1796 GRAND RIDGE CT NE, GRAND RAPIDS, MI 49525-7035
(616) 724-7824
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/01/2021
Last updated
10/01/2021
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