Provider Demographics
NPI:1770649741
Name:WALLACE, PAUL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:WALLACE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8305 WALNUT HILL LN
Mailing Address - Street 2:SUITE 235
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4217
Mailing Address - Country:US
Mailing Address - Phone:214-692-1050
Mailing Address - Fax:214-361-1936
Practice Address - Street 1:8305 WALNUT HILL LN
Practice Address - Street 2:SUITE 235
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4217
Practice Address - Country:US
Practice Address - Phone:214-692-1050
Practice Address - Fax:214-361-1936
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX017349561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice