Michael James Wallace, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2515 Issued in WI

Practice address

1195 W Mason St
Green Bay, WI 54303-2045

Phone

(920) 498-3633

Fax

(920) 498-1099

NPI assigned

Sep 22, 2006

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124127279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1195 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032045",
            "telephone_number": "920-498-3633",
            "fax_number": "920-498-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 W MASON ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032045",
            "telephone_number": "920-498-3633",
            "fax_number": "920-498-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eldena Walker, FNP
• Erin M Walker, R.N.
• James Walker Jr.
• Marie A Walker, M.D.
• Caitlin Wall
• Alyssa Ruth Waller
• Walter J. Ratschan, M.D., S.C.
• Heather Walters
• Matthew P Walters, MD
• Trisha Ann Walton, APNP

• General Practice Dentistry in Green Bay, WI
• Providers in Green Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.