Individual
DR. RICHARD J WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
20921 E SMOKY HILL RD, SUITE A, CENTENNIAL, CO 80015
(303) 690-7778
(303) 690-1158
Mailing address
20921 E SMOKY HILL ROAD, SUITE A, CENTENNIAL, CO 80015
(303) 690-7778
(303) 690-1158
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
105208
CO
Other
Enumeration date
08/30/2005
Last updated
09/15/2010
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