Stephen Leon Wallace

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DS0000004001 Issued in TN

Practice address

225 Dunbar Cave Rd Ste B
Clarksville, TN 37043-8846

Phone

(931) 552-5332

Fax

(931) 552-6348

NPI assigned

Aug 31, 2007

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

Other names 1

• Stephen Leon Wallace Professional name

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": "1188518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188518400000",
    "number": "1205020286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 DUNBAR CAVE RD STE B",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438846",
            "telephone_number": "931-552-5332",
            "fax_number": "931-552-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 DUNBAR CAVE RD STE B",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438846",
            "telephone_number": "931-552-5332",
            "fax_number": "931-552-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "STEPHEN",
        "middle_name": "LEON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-31",
        "last_updated": "2007-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TN",
            "license": "DS0000004001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHEN",
            "last_name": "WALLACE",
            "middle_name": "LEON",
            "credential": "D.D.S.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Danielle Wallace
• Jane Lambert Wallace, M.S., CCC-SLP
• Morgan Wallace, MSW
• Paula Renee Wallace, BSW
• Sarah Wallace, PHARMD
• Crystal Lynn Wallenius
• Rayann Walls
• Eileen Marie Walsh, BSW
• Sarah Elaine Walter, BCABA , TN LABA
• Keyodona Walton, MA, BCBA, LBA

• Orthodontics and Dentofacial Orthopedics Dentistry in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.