| Mark A Wallace, D.d.s., L.l.c. | |
|
1901 Research Blvd Suite 200 Rockville MD 20850-3164 | |
| (301) 309-0707 | |
| (301) 309-8169 |
| Full Name | Mark A Wallace, D.d.s., L.l.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1901 Research Blvd, Rockville, Maryland |
| Authorized Official Name and Position | Mark A Wallace (DENTIST) |
| Authorized Official Contact | 3013090707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark A Wallace, D.d.s., L.l.c. 1901 Research Blvd Suite 200 Rockville MD 20850-3164 Ph: (301) 309-0707 | Mark A Wallace, D.d.s., L.l.c. 1901 Research Blvd Suite 200 Rockville MD 20850-3164 Ph: (301) 309-0707 |
| NPI Number | 1891985974 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 07/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891985974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5043 (Maryland) | Primary |
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