Individual
DR. KEVIN D WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD PC
Contact information
Practice address
1200 E WOODHURST DR STE A200, SPRINGFIELD, MO 65804-3745
(417) 881-1123
(417) 883-0812
Mailing address
1200 E WOODHURST DR STE A200, SPRINGFIELD, MO 65804-3745
(417) 881-1123
(417) 883-0812
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
014935
MO
Other
Enumeration date
08/21/2008
Last updated
08/21/2008
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