Mark Spangler Wallace, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

142818-9921 Issued in UT

Practice address

168 N 1950 W Ste 202
Salt Lake City, UT 84116-3007

Phone

(801) 715-3400

NPI assigned

Sep 20, 2005

Sex

Male

Sole proprietor

No

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1669467213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "168 N 1950 W STE 202",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841163007",
            "telephone_number": "801-715-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "168 N 1950 W STE 202",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841163007",
            "telephone_number": "801-715-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARK",
        "middle_name": "SPANGLER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "142818-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Michael Wallace, M.D.
• Jennifer Wallace
• John Mark Wallace, R.PH.
• Justice Kassidy Wallace
• Laney Wallace
• Marshall W. Wallace, MD
• Rebecca Wallace, APRN
• Robert Duncan Wallace, M.D.
• Sara Elizabeth Wallace, DPT
• Rachel Jo Wallenda

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; 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.