DR. DAVID ALLEN WALLACE DDS MS NPI 1386646206

NPI Information

NPI: 1386646206
Provider Name: DR. DAVID ALLEN WALLACE, DDS, MS
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

Address:
206 S WALKER ST
PRINCETON, WV
ZIP 24740
Phone: (304) 425-2611
Get Directions

DR. David Allen Wallace, DDS, MS is an oral and maxillofacial surgery dentist in Princeton, WV. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. David Allen Wallace, DDS, MS NPI is 1386646206. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

206 S WALKER ST
PRINCETON, WV
ZIP 24740-747
Phone: (304) 425-2611

The enumeration date for this NPI number is 8/11/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223S0112X	Dentist	Oral and Maxillofacial Surgery	0401003440	VIRGINIA	No
2	1223S0112X	Dentist	Oral and Maxillofacial Surgery	1880	WEST VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	WA0499202	MEDICARE ID-TYPE UNSPECIFIED	WEST VIRGINIA
2	0138333000	MEDICAID	WEST VIRGINIA
3	800476	MEDICAID	VIRGINIA
4	T21823	MEDICARE UPIN	WEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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