The Wallace Medical Concern

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

THE WALLACE MEDICAL CONCERN

Practice address

18139 NE Couch St
Portland, OR 97230-7222

Phone

(503) 489-1760

NPI assigned

Mar 30, 2016

Last updated

Sep 17, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Sirianni

Title

Director of Compliance

Phone

(714) 330-3275

Specialties & licenses 3

Addresses

Tax ID family

The Wallace Medical Concern4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• The Wallace Medical Concern

  dba Wallace

  • Dentist
  • Portland, OR
  • NPI 1215390091
  NPD tax ID
• The Wallace Medical Concern

  • Dental Clinic/Center
  • Portland, OR
  • NPI 1558033118
  NPD tax ID
• The Wallace Medical Concern

  dba Wallace

  • Family Medicine Physician
  • Gresham, OR
  • NPI 1881429918
  NPD tax ID

Locations

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789603200000",
    "number": "1215390109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18139 NE COUCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972307222",
            "telephone_number": "503-489-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18139 NE COUCH ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972307222",
            "telephone_number": "503-489-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE WALLACE MEDICAL CONCERN",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A",
        "authorized_official_last_name": "SIRIANNI",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "714-330-3275"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The Wallace Medical Concern
• The Wallace Medical Concern (Wallace)
• The Wellness Center PDX
• The Wig Gallery LLC
• Sandra Thein

• Dentist in Portland, OR
• Providers in Portland, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; 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.