Michael J. Wallace D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5801 Issued in OK

Legal business name

MICHAEL J. WALLACE D.D.S.

Practice address

1600 E 19TH St
Suite 301
Edmond, OK 73013-6622

Phone

(405) 340-0411

Fax

(405) 340-3217

NPI assigned

Jan 31, 2007

Last updated

Aug 22, 2020By 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

Dr. Michael J Wallace, D.D.S.NPI 1417014424

Title

Dentist

Phone

(405) 340-0411

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael J Wallace, DDS

  • Dentist
  • Edmond, OK
  • NPI 1417014424
  NPD (past) Authorized official

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669519559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E 19TH ST",
            "address_2": "SUITE 301",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730136622",
            "telephone_number": "405-340-0411",
            "fax_number": "405-340-3217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E 19TH ST",
            "address_2": "SUITE 301",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730136622",
            "telephone_number": "405-340-0411",
            "fax_number": "405-340-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. WALLACE D.D.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "405-340-0411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "5801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael a Spears DC PC
• Michael B. Grindstaff, O.D., P.C. (Optique Vision Center)
• Michael D John MD PC
• Michael D. Swafford, Psy.D., P.C.
• Michael F. Alspaugh
• Michael L Glass MD Inc
• Michael M. Cheng, DDS PC
• Michael Thrower MD, PLLC
• Medhat S.F. Michael, M.D.
• Michelle Blank, LCSW, PLLC

• General Practice Dentistry in Edmond, OK
• Providers in Edmond, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.