DR. MICHAEL JAMES WALLACE


Address: 1195 W Mason St, Green Bay, WI 54303-2045
Phone: 9204983633

DR. MICHAEL JAMES WALLACE (NPI# 1124127279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1124127279
Entity Type Individual
Full Name DR. MICHAEL JAMES WALLACE
Credential DDS
Practice Address 1195 W Mason St
Green Bay
WI 54303-2045
Practice Telephone 9204983633
Practice Fax Number 9204981099
Mailing Telephone 9204983633
Mailing Fax Number 9204981099
Enumeration Date 2006-09-22
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 1223G0001X Dentist
Specialization: General Practice
2515 WI Dental Providers

Other Providers MICHAEL WALLACE

NPI Name Taxonomy Address Enumeration
1417014424 Michael J Wallace Dentist 1600 E 19th St, Suite 301, Edmond, OK 73013-6622 2007-01-02
1518042696 Michael J. Wallace Dentist 1263 High St, Auburn, CA 95603-5016 2006-10-26
1679585038 Michael Patrick Wallace Dentist 9225 Manchester Rd, Suite 101, Saint Louis, MO 63144-2640 2006-08-13
1467438937 Michael Lloyd Wallace Pathology 522 Alpha Dr, Pittsburgh, PA 15238-2912 2005-12-16
1609356864 Michael Wallace Physical Therapy Assistant 5455 Knickerbocker Rd, San Angelo, TX 76904-7711 2018-08-17
1225579899 Michael Wallace Counselor 500 Allerton St, Second Floor, Redwood City, CA 94063-1519 2017-03-16
1376922948 Michael Taylor Wallace Ophthalmology 930 Madison Ave Ste 200, Memphis, TN 38103 2015-05-28
1194029777 Michael T Wallace Nurse Practitioner 9900 Bren Rd E, Minnetonka, MN 55343-9664 2010-12-22
1003116658 Michael Eugene Wallace Psychologist 201 E Liberty St, Suite 2, Ann Arbor, MI 48104-2118 2010-10-29
1003057852 Michael Alan Wallace Nurse Practitioner 8210 Louisiana Blvd Ne, Suite C, Albuquerque, NM 87113-1761 2009-03-07

Office Location

Street Address 1195 W MASON ST
City GREEN BAY
State WI
Zip Code 54303-2045

Providers in the same location

NPI Name Taxonomy Address Enumeration
1023670254 Austin Allen Iverson Dentist 1195 W Mason St, Green Bay, WI 54303 2019-07-09
1801305271 Willow Cove Dental, LLC Clinic/Center 1195 W Mason St, Green Bay, WI 54303-2045 2017-09-28

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1952921033 Ashley Marie Vandermoss Social Worker 1601 W Mason Street, Green Bay, WI 54303 2020-04-20
1598307423 Jean Marie Castaneda Case Manager/Care Coordinator 2517 N. Court, Green Bay, WI 54303 2019-10-11
1215579552 Integrated Treatment Centers, LLC Clinic/Center 2311 W Mason Street, Green Bay, WI 54303 2019-10-08
1003460551 Affordable Dentures & Implants - Green Bay, S.c. Dentist 1800-c W. Mason Street, Green Bay, WI 54303 2019-08-01
1164940375 Kaeley Rae Blaney Student in an Organized Health Care Education/Training Program 2088 Memorial Drive #208, Green Bay, WI 54303 2017-09-07
1518498047 Treatment Providers LLC Clinic/Center 2731 N Packerland Dr Ste A, Green Bay, WI 54303 2017-03-26
1851840565 Back To Balance Chiropractic, LLC Chiropractor 110 Packerland Drive, Suite B, Green Bay, WI 54303 2016-09-23
1710361001 Matthew Lemay Acupuncturist 727 E Walnut, Suite B2, Green Bay, WI 54303 2015-07-16
1144600149 Carrie Jean Banaszak Counselor 1039 Mason Street, Green Bay, WI 54303 2015-06-04
1174921993 Kensey Meyer Occupational Therapy Assistant 1555 Dousman Road, Seymour, WI 54303 2014-12-10
Find all providers in zip 54303

Taxonomy Information

Taxonomy Code 1223G0001X
Grouping Dental Providers
Classification Dentist
Specialization General Practice

Taxonomy Definition

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.
Notes: Source: Academy of General Dentistry

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1124670898 Robert H Wagner Family Dentist S.c. Dentist 2830 Curry Court, Suite 1, Green Bay, WI 54311 2019-07-12
1386102465 Parc Village Dental, LLC Dentist 2805 Libal Street, Suite A, Green Bay, WI 54301 2019-03-07
1578052866 Matthew Robert Wagner Dentist 2830 Curry Ln #1, Green Bay, WI 54311 2018-05-02
1588197149 Familia Dental West Green Bay Dentist 2280 W Mason St, Green Bay, WI 54303-4707 2017-04-10
1225489974 Nicholas Van Ess Dentist 1640 Main St Stop 1, Green Bay, WI 54302-2639 2016-06-23
1063822328 Jessica Leigh Pasono Dentist 2609 Development Dr, Green Bay, WI 54311 2014-05-07
1063622645 Echo Ridge Dental Clinic Dentist 2140 S. Ridge Rd., Green Bay, WI 54304 2007-05-23
1710191085 Lisa Rachel Piontek Dentist 526 S Monroe Ave, Green Bay, WI 54301-4018 2007-05-09
1831301290 Family Dental Center of Green Bay, S.c. Dentist 2247 Fox Heights Ln, Green Bay, WI 54304-4747 2007-05-05
1194946079 Kirk Richard Fishbaugh Dentist 2625 Tulip Ln, Green Bay, WI 54313-6855 2007-05-01
Find all providers in GREEN BAY

Competitor

Search similar providers

City GREEN BAY
Zip Code 54303

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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