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Contact Information

HEATH R WALLACE
13160 MAIN STREET
WESTON, OH43569
 Phone: 419-669-2839
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for HEATH R WALLACE · (Male)

NPI Number 1811010069
Status Active
Credentials
Entity Individual
Enumeration date 04/10/2007
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • OH License # 30-022208
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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