Lawrence Norman Wallace
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Carmel Valley, CA
NPI 1043486962 · NPPES record last updated Apr 30, 2008
Key facts
- NPI
- 1043486962
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 21-770 (IL)
- Practice address
- 2 Middle Canyon Rd
Carmel Valley, CA 93924-9404 - Phone
- (831) 659-9300
- NPI assigned
- Apr 30, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21-770 | IL | MD | Oral and Maxillofacial Surgery (Dentist) |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 21-770 | IL | Yes |
Addresses
Primary practice location
2 Middle Canyon Rd
Carmel Valley, CA 93924-9404
Mailing address
2 Middle Canyon Rd
Carmel Valley, CA 93924-9404
Phone (831) 659-9300
Other providers in Carmel Valley, CA
- Smith Wolff Chiropractic Inc
- Vladi Starkov
- Gregory Alan Thompson
- Tigerlily Women'S Health & Midwifery
- David Edward Villareal
- Barbara Ruth West
- Tieshiea D Wolf
- Patricia E Wolff
- Damon Wood
All providers in Carmel Valley, CA · Oral and Maxillofacial Surgery (Dentist) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.