Organization
KENNETH F. WALLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH FRANKLIN WALLACE DMD (DENTIST)
(859) 283-1986
Entity
Organization
Contact information
Practice address
280 MOUNT ZION RD, SUITE D, FLORENCE, KY 41042-3217
(859) 283-1986
(859) 283-2586
Mailing address
280 MOUNT ZION RD, SUITE D, FLORENCE, KY 41042-3217
(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
—
60063864
—
KY
Enumeration date
06/10/2008
Last updated
06/10/2008
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