NPI 1376698753

Douglas W. Wallace, DDSMS

Practitioner Oral & Maxillofacial Surgery (D.M.D.) Fairfield, OH

Practice location

Address: 5188 Winton Rd, Fairfield, OH 45014-2900
Phone: (513) 829-8080
Fax: (513) 858-4290

Registered specialties

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X Licence 30-01-6806 (OH)

Other Oral & Maxillofacial Surgery providers in Ohio →

Registry record

NPI: 1376698753
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Jan 2007
Record last updated: 1 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.