Brandon Tobias Wallace, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30.027636 Issued in OH

Practice address

4605 E Galbraith Rd Ste 100
Cincinnati, OH 45236-2888

Phone

(513) 961-1991

NPI assigned

Apr 15, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cincinnati Dental Group LLC

  • Dental Clinic/Center
  • Cincinnati, OH
  • NPI 1376180562
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1093569204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 HARRISON AVE PH 19",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021184095",
            "telephone_number": "910-580-5699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 E GALBRAITH RD STE 100",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452362888",
            "telephone_number": "513-961-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRANDON",
        "middle_name": "TOBIAS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-15",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.027636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wallace Physician Services LLC
• Alex Wallace, MA, LMHC, LPCC
• Alexandria Wallace
• Allison Wallace, MSW, MFT
• Anne M. Wallace, PH.D.
• Chasei Wallace
• Chiquita Wallace
• Christina Wallace
• Christine Wallace, MD
• Donielle R Wallace

• General Practice Dentistry in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.