Wallace Colvin PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WALLACE COLVIN PC

Practice address

69 Southbound Gratiot Ave Lowr
Mount Clemens, MI 48043-7600

Phone

(586) 783-7000

Fax

(586) 783-7003

NPI assigned

Nov 3, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Wallace S Colvin, DDS

Title

Dentist

Phone

(586) 783-7000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478131200000",
    "number": "1952853103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 SOUTHBOUND GRATIOT AVE LOWR",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480437600",
            "telephone_number": "586-783-7000",
            "fax_number": "586-783-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 SOUTHBOUND GRATIOT AVE LOWR",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480437600",
            "telephone_number": "586-783-7000",
            "fax_number": "586-783-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE COLVIN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-03",
        "last_updated": "2016-11-03",
        "status": "A",
        "authorized_official_last_name": "COLVIN",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "586-783-7000",
        "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": []
}

• Valerie Rose Voce, DO
• Brianne Colleen Waggoner, D.O
• Rachel Wagner
• Erin Waldorf, LLMSW
• Chastity Walker
• Jodi Walny, MA, LLPC, CAADC-DP
• James Robert Walsdorf
• Michael Walsh
• Hannah Walters
• Richard Green Walton, DO

• Dental Clinic/Center in Mount Clemens, MI
• Providers in Mount Clemens, 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 Nov 3, 2016; 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.