Benjamin C. Wallace DDS, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BENJAMIN C. WALLACE DDS, PLLC

Practice address

1330 W Washington St
Greenville, MI 48838-2190

Phone

(616) 754-7414

NPI assigned

Oct 1, 2021

Last updated

Oct 1, 2021By 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. Benjamin Wallace, DDSNPI 1033647516

Title

Owner

Phone

(616) 724-7824

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, and the practitioner matching its NPPES authorized official.

• Benjamin Wallace, DDS

  • General Practice Dentistry
  • Fremont, MI
  • NPI 1033647516
  NPD Authorized official

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1841962529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1796 GRAND RIDGE CT NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257035",
            "telephone_number": "616-724-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 W WASHINGTON ST",
            "city": "GREENVILLE",
            "state": "MI",
            "postal_code": "488382190",
            "telephone_number": "616-754-7414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENJAMIN C. WALLACE DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-724-7824",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Souhad Bazzi, PHARMD
• Be Still & Be Known Counseling, LLC
• Lauren Michelle Beghtol, DO
• Katherine Marie Behrenwald, PA-C
• Jenna Bellows
• Jamie Bice
• Melissa Boland
• Kristen Brinker
• Krystle Brodbeck
• Ada M Brosier, LMSW

• Dental Clinic/Center in Greenville, MI
• Providers in Greenville, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.