Individual
MATTHEW SEYMOUR WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
63 GEIGER RD, ROME, NY 13441-4324
(315) 339-2120
Mailing address
63 GEIGER RD, ROME, NY 13441-4324
(315) 335-0164
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055556
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/29/2010
Last updated
08/08/2012
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