Michael P. Wallace D.M.D., PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13992 Issued in MO

Legal business name

MICHAEL P. WALLACE D.M.D., PC

Practice address

9225 Manchester Rd
Suite 101
Saint Louis, MO 63144-2640

Phone

(314) 968-0003

Fax

(314) 968-0383

NPI assigned

Jan 8, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Michael Patrick Wallace, D.M.D.NPI 1679585038

Title

Owner

Phone

(314) 968-0003

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Patrick Wallace, DMD

  • Dentist
  • Saint Louis, MO
  • NPI 1679585038
  NPD (past) Authorized official

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

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1275770513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9225 MANCHESTER RD",
            "address_2": "SUITE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631442640",
            "telephone_number": "314-968-0003",
            "fax_number": "314-968-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9225 MANCHESTER RD",
            "address_2": "SUITE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631442640",
            "telephone_number": "314-968-0003",
            "fax_number": "314-968-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL P. WALLACE D.M.D., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-08",
        "last_updated": "2009-01-08",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-968-0003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "13992",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael D Weiss DPM and Associates, LLC
• Michael J Spezia DO Inc
• Michael J. Hoffmann D.D.S.
• Michael J. Milne M.D., L.L.C.
• Michael P. Travis, DDS LLC
• Michael W Noble DMD PC
• Alex Patrick Michael, MD
• Arielle Michael, PHARMD
• Gina Lucette Michael, M.D.
• Megan M Michael, PA-C

• General Practice Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; 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.