C M WALLACE DDS PA NPI 1578612925

NPI Information

C M WALLACE DDS PA is a general practice dentist in Bonita Springs, FL. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. C M WALLACE DDS PA NPI is 1578612925. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

8951 BONITA BEACH RD
BONITA SPRINGS, FL
ZIP 34135-201
Phone: (239) 992-8555
Fax: (239) 992-8644

The provider's authorized official is Charles Macon Wallace .
The authorized official title is Owner President and has the following contact phone number (239) 643-4746.

The enumeration date for this NPI number is 1/8/2007 and was last updated on 9/29/2010.

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:

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.