Wallace Family Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WALLACE FAMILY DENTISTRY LLC

Practice address

5258 Montgomery Rd
Cincinnati, OH 45212-1648

Phone

(513) 531-2338

Fax

(513) 841-5545

NPI assigned

Dec 2, 2025

Organization subpart

No

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

Authorized official

Name

Jared R Graham, DDSNPI 1093371387

Title

Managing Member

Phone

(513) 531-2338

Specialties & licenses 2

Addresses

Practitioners 2

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

• Jared Richard Graham, DDS

  • General Practice Dentistry
  • Norwood, OH
  • NPI 1093371387
  NPD (past) Authorized official
• Bruce A Mrusek, DDS

  • General Practice Dentistry
  • Norwood, OH
  • NPI 1003993510
  NPD (past)

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

{
    "created_epoch": "1764633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1649132192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5258 MONTGOMERY RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452121648",
            "telephone_number": "513-531-2338",
            "fax_number": "513-841-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5258 MONTGOMERY RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452121648",
            "telephone_number": "513-531-2338",
            "fax_number": "513-841-5545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-02",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "513-531-2338",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric J Wall, M.D.
• Madison Wall
• Quinton Wall
• Sheila Wall, MD
• Shelby Wall
• Wallace Physician Services LLC
• Alexandria Wallace
• Allison Wallace, MSW, MFT
• Anne M. Wallace, PH.D.
• Brandon Tobias Wallace, DMD

• 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 Sep 14, 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.