| Kevin D Wallace Dmd, Pc | |
|
1200 E Woodhurst Dr Suite 200-a Springfield MO 65804-4257 | |
| (417) 881-1123 | |
| (417) 883-0812 |
| Full Name | Kevin D Wallace Dmd, Pc |
|---|---|
| Speciality | Dentist - Prosthodontics |
| Location | 1200 E Woodhurst Dr, Springfield, Missouri |
| Authorized Official Name and Position | Kevin D Wallace (DENTIST) |
| Authorized Official Contact | 4178811123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kevin D Wallace Dmd, Pc 1200 E Woodhurst Dr Suite 200-a Springfield MO 65804-4257 Ph: (417) 881-1123 | Kevin D Wallace Dmd, Pc 1200 E Woodhurst Dr Suite 200-a Springfield MO 65804-4257 Ph: (417) 881-1123 |
| NPI Number | 1841404019 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 08/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841404019 | NPI | - | NPPES |
| WA405263807 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 014935 (Missouri) | Primary |
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