MARK CHARLES WALLACE, DDS, PC (NPI# 1184046385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184046385 |
| Entity Type | Organization |
| Organization Name | MARK CHARLES WALLACE, DDS, PC |
| Other Organization Name | ADVANCED DENTAL GROUP |
| Practice Address |
3909 Silver Lake Rd Ne Minneapolis MN 55421-4352 |
| Practice Telephone | 6127893573 |
| Mailing Telephone | 6127893573 |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2014-01-08 |
| Authorized Official Name | REBECCA M KIPP (OFFICE MANAGER) |
| Authorized Official Telephone | 6127893573 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Advanced Dental Group | Doing Business As Name - Organization |
| Street Address |
3909 SILVER LAKE RD NE |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55421-4352 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417020017 | Glenn I Lepor | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2006-11-15 |
| 1598374480 | Andy Aldrich | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2020-07-27 |
| 1881060069 | Modern Dental Professionals, Mn PC | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2015-08-11 |
| 1275707580 | Advanced Dental Group | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2008-04-17 |
| 1174695936 | John David Steen | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2006-11-15 |
| 1891867669 | Howard W Taylor | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2006-11-15 |
| 1245303775 | Raymond Hellickson | Dentist | 3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352 | 2006-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982241782 | Cc Group Home Care Inc | Non-emergency Medical Transport (VAN) | 524 Huset Pkwy Ne, Columbia Heights, MN 55421 | 2019-11-30 |
| 1710455324 | Victoria F Renner | Physical Therapist | 4512, 3700 Foss Rd, Minneapolis, MN 55421 | 2018-11-13 |
| 1245721976 | Complete Care Home Care LLC | Home Health | 4111 Central Ave Ne North Building, Suite 202, Columbia Heights, MN 55421 | 2018-05-29 |
| 1053816389 | Anoka Health Center LLC | Clinic/Center | 4111 Central Ave N.e, Suite 201 North Building, Columbia Heights, MN 55421 | 2018-03-28 |
| 1508381047 | Minnesota Home Health Care LLC | Home Health | 534 Huset Parkway, Columbia Heights, MN 55421 | 2017-08-05 |
| 1720520448 | Tesfa International School | Local Education Agency (LEA) | 1550 40th Avenue Northeast, Columbia Heights, MN 55421 | 2016-11-11 |
| 1487012548 | Icare Transportation | Non-emergency Medical Transport (VAN) | 2816 Silver Ln Ne #305, Saint Anthony, MN 55421 | 2016-02-04 |
| 1194183368 | Warsame Warsame | Non-emergency Medical Transport (VAN) | 1115 45th Ave Ne, Columbia Heights, MN 55421 | 2016-02-03 |
| 1083083398 | Epic Transportation LLC | Clinic/Center | 355 Orendorff Way Ne, Columbia Heights, MN 55421 | 2015-09-16 |
| 1508281023 | Alexandra Marie Hodson | Occupational Therapist | 5155 E. River Rd, Suite #403, Fridley, MN 55421 | 2014-02-20 |
| Find all providers in zip 55421 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679182687 | Downtown Dental Center Pllc | Dentist | 825 Nicollet Mall Ste 1427, Minneapolis, MN 55402-2703 | 2020-07-26 |
| 1205444791 | Patrick Reilly Steck | Dentist | 4948 S 34th Ave, Minneapolis, MN 55417 | 2020-07-21 |
| 1124684725 | Eric James Holthaus | Dentist | 825 Nicollet Ave #1025, Minneapolis, MN 55402 | 2019-05-20 |
| 1154811404 | Mohamed Mukhtar Ali | Dentist | 4700 Cedar Ave S, Minneapolis, MN 55407 | 2018-05-12 |
| 1154828283 | Ari Michael Lederman | Dentist | 825 Nicollet Mall Ste 425, Minneapolis, MN 55402-2608 | 2018-04-05 |
| 1730604877 | Daryl Grigsby Jr. | Dentist | 515 Delaware St Se # 8-166, Minneapolis, MN 55455-0357 | 2017-08-10 |
| 1033630371 | Margaret Elizabeth Craven | Dentist | 250 2nd Ave S Ste 250, Minneapolis, MN 55401-2173 | 2017-06-27 |
| 1013330661 | Helen Oboro-onuora | Dentist | 606 24th Ave S Suite 200, Umphysicians Dental Clinic, Minneapolis, MN 55454 | 2014-01-31 |
| 1548690001 | Patrick J. Foy Dds,pa | Dentist | 606 24th Ave S Ste 806, Minneapolis, MN 55454-1438 | 2013-11-20 |
| 1659719078 | Deanna Miller | Dentist | 3428 20th Ave S, Minneapolis, MN 55407-2408 | 2013-06-07 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55421 |
Please comment or provide details below to improve the information on MARK CHARLES WALLACE, DDS, PC.
| 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.