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DR. STEPHEN S WALLACE DDS NPI 1679868822


NPI Information

NPI: 1679868822
Provider Name: DR. STEPHEN S WALLACE, DDS
Classification: Dentist - 1223P0300X
Entity Type: Individual

Specialization: Periodontics

PECOS Registration: Yes

Address:
140 GRANDVIEW AVE
SUITE 102
WATERBURY, CT
ZIP 06708
Phone: (203) 753-1112
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DR. Stephen S Wallace, DDS is a periodontics dentist in Waterbury, CT. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. DR. Stephen S Wallace, DDS NPI is 1679868822. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

140 GRANDVIEW AVE
SUITE 102
WATERBURY, CT
ZIP 06708-505
Phone: (203) 753-1112
Fax: (203) 573-0773

The NPI 1679868822 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/16/2011 and was last updated on 3/29/2012.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0300XDentistPeriodontics044912-1NEW YORKNo
21223P0300XDentistPeriodonticsDN11169MASSACHUSETTSNo
31223P0300XDentistPeriodontics4383CONNECTICUTYes

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: 4/28/2024

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.