Organization
MARK A WALLACE, D.D.S., L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A WALLACE D.D.S. (DENTIST)
(301) 309-0707
Entity
Organization
Contact information
Practice address
1901 RESEARCH BLVD, SUITE 200, ROCKVILLE, MD 20850-3164
(301) 309-0707
(301) 309-8169
Mailing address
1901 RESEARCH BLVD, SUITE 200, ROCKVILLE, MD 20850-3164
(301) 309-0707
(301) 309-8169
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5043
MD
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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