Individual
KENNETH F WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
280 MT ZION RD, SUITE D, FLORENCE, KY 41042
(859) 283-1986
(859) 283-2586
Mailing address
PO BOX 1066, FLORENCE, KY 41022-1066
(859) 283-1986
(859) 283-2586
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6386
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61942850
—
KY
Enumeration date
02/12/2007
Last updated
11/04/2015
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