| C M Wallace Dds Pa | |
|
8951 Bonita Beach Rd Bonita Springs FL 34135-4201 | |
| (239) 992-8555 | |
| (239) 992-8644 |
| Full Name | C M Wallace Dds Pa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8951 Bonita Beach Rd, Bonita Springs, Florida |
| Authorized Official Name and Position | Charles Macon Wallace (OWNER PRESIDENT) |
| Authorized Official Contact | 2396434746 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| C M Wallace Dds Pa 8951 Bonita Beach Rd Bonita Springs FL 34135-4201 Ph: (239) 992-8555 | C M Wallace Dds Pa 8951 Bonita Beach Rd Bonita Springs FL 34135-4201 Ph: (239) 992-8555 |
| NPI Number | 1578612925 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 09/29/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578612925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN14024 (Florida) | Primary |
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