National Provider Identifier Database

KEVIN R WALLACE, DMD – NPI #1053423285
General Practice

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.


Contact Information

KEVIN R WALLACE, DMD
150 E HURON ST
STE 1103
CHICAGO, IL60611
Phone: 312-676-9893
Fax: 815-744-7059
Website:
Specialty Taxonomy Code
* General Practice 1223G0001X
Dentist 122300000X

* Indicates primary specialty

NPI Profile & details for KEVIN R WALLACE

NPI Number 1053423285
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 09/01/2006
Last updated 01/19/2021 - About 5 years ago
Sole proprietor1 No
Identifiers
  • IL License #: 019-022339
  • IL License #: 019022339
  • IL Other: 019-022339 DENTAL-IL
  • IL Other: 1053431981 GROUP TYPE II NPI
  • IL Other: 1063649770 GROUP TYPE II NPI
  • IL Other: 1205145554 PRACTICE LOCATION TYPE II NPI
  • IL Other: 1295165439 PRACTICE LOCATION TYPE II NPI
  • IL Other: 1306177241 PRACTICE LOCATION TYPE II NPI
  • IL Other: 1508198474 PRACTICE LOCATION TYPE II NPI
  • IL Other: 1760882005 PRACTICE LOCATION TYPE II NPI
Hospital affiliation n/a

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.

Reviews for KEVIN R WALLACE, DMD

There are currently no reviews for KEVIN R WALLACE, DMD


NPIdb - Home
v2.201