Provider Demographics
NPI:1790899367
Name:PRICE, WALLACE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:C
Last Name:PRICE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 HENRY RD
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-6344
Mailing Address - Country:US
Mailing Address - Phone:256-238-1121
Mailing Address - Fax:256-237-0579
Practice Address - Street 1:3310 HENRY RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-6344
Practice Address - Country:US
Practice Address - Phone:256-238-1121
Practice Address - Fax:256-237-0579
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3452CS1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice