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General NPI Number Information
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NPI Number | 1356535314
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Entity Type | Organization
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Legal Business Name | JOHN D. WALLACE, DDS, MD, PA
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 8315 WALNUT HILL LN STE 120
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City | DALLAS
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State | TX
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Zip | 75231-4218
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Country | US
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Telephone | 214-363-9946
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Fax | 214-389-1953
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Provider Business Mailing Address
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Address Line | 8315 WALNUT HILL LN SUITE 120
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City | DALLAS
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State | TX
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Zip | 75231-4218
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Country | US
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Telephone | 214-363-9946
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Fax | 214-389-1953
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Authorized Official
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Title or Position | DOCTOR
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Name | JOHN D WALLACE
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Credential | DDS, MD
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Telephone | 214-334-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 19862
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License Number State | TX
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