Individual provider · Type 1 NPI

Kevin R. Wallace, DMD

General Practice Dentistry · Chicago, IL

NPI number 1053423285 Active

Practice location

150 E Huron St, Ste 1103
Chicago, IL 60611

Call (312) 676-9893 Map

Fax (815) 744-7059

Mailing address

14831 W 159th St Ste 1
Lockport, IL 60491-9008

Specialties and licenses

TaxonomyCodeLicense
Dentist 122300000X019022339 (IL)
Dentist 122300000X019-022339 (IL)
General Practice Dentistry Primary 1223G0001X019022339 (IL)

General Practice Dentistry: 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.

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About NPI 1053423285

Kevin R. Wallace, DMD's National Provider Identifier is 1053423285, issued on Sep 1, 2006. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in Chicago, IL. The record was last updated on Jan 19, 2021.