DR. KEVIN D WALLACE (NPI# 1972750909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972750909 |
| Entity Type | Individual |
| Full Name | DR. KEVIN D WALLACE |
| Credential | DMD PC |
| Practice Address |
1200 E Woodhurst Dr Ste A200 Springfield MO 65804-3745 |
| Practice Telephone | 4178811123 |
| Practice Fax Number | 4178830812 |
| Mailing Telephone | 4178811123 |
| Mailing Fax Number | 4178830812 |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-08-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
014935 | MO | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659760700 | Kevin Wallace | Naturopath | 1700 N Tully Rd Apt G221, Turlock, CA 95380-6879 | 2015-01-13 |
| 1144576919 | Kevin Gary Wallace | Pharmacist | 94 Ladd Ave, Staten Island, NY 10312-1515 | 2012-07-31 |
| 1316960131 | Kevin Bruce Wallace | Dentist | 949 N 14th St, Leesburg, FL 34748-3838 | 2006-07-25 |
| 1033619614 | Kevin R Wallace | Case Manager/Care Coordinator | 3620 Stutz Dr, Canfield, OH 44406-9176 | 2018-02-20 |
| 1518391135 | Kevin Wallace | Massage Therapist | 817 Coffee Rd Ste D, Modesto, CA 95355-4241 | 2013-08-30 |
| 1225388457 | Kevin Wallace | Student in an Organized Health Care Education/Training Program | 30 Warren St, Boston, MA 02135-3602 | 2012-09-14 |
| 1053423285 | Kevin R Wallace | Dentist | 150 E Huron St, Ste 1103, Chicago, IL 60611 | 2006-09-01 |
| 1730128372 | Kevin L Wallace | Preventive Medicine | 925 E Mcdowell Rd, Phoenix, AZ 85006-2502 | 2006-06-06 |
| 1255309258 | Kevin Ps Wallace | Internal Medicine | 1300 Crane St, Menlo Park, CA 94025-4260 | 2006-03-08 |
| 1033195631 | Kevin H Wallace | Internal Medicine | 1350 Hickory St, Melbourne, FL 32901-3224 | 2005-12-16 |
| Street Address |
1200 E WOODHURST DR STE A200 |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65804-3745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790393049 | Kathy Forson | Nurse Practitioner | 1235 E. Cherokee St., Springfield, MO 65804 | 2020-07-22 |
| 1306498779 | Anne B Summers, LLC | Social Worker | 1310 E. Kingsley St., Ste C, Springfield, MO 65804 | 2019-07-15 |
| 1790241800 | Margaret Mary Hart | Social Worker | 1845 S Rogers Ave, Springfield, MO 65804 | 2019-02-13 |
| 1598254666 | Casey Carr | Optometrist | 1229 E Seminole St Ste 110, Springfield, MO 65804 | 2018-05-04 |
| 1124520697 | Shelby D White | Behavioral Analyst | 1300 E. Bradford Parkway, Springfield, MO 65804 | 2018-03-01 |
| 1316448343 | Karl Lynham | Massage Therapist | 1200 E Woodhurst Dr R300, Springfield, MO 65804 | 2018-02-25 |
| 1699273763 | Leah Wilson | Counselor | 1322 E Woodgate, Springfield, MO 65804 | 2018-01-24 |
| 1295242626 | Matthew Crisp | Physical Therapist | 3252 E Independence St, Springfield, MO 65804 | 2018-01-08 |
| 1518491042 | Crystal Spangler | Dietitian, Registered | 1965 S Fremont Ave Ste 220, Springfield, MO 65804 | 2017-04-11 |
| 1588012033 | Jeffrey Williams | Pharmacist | 1235 E. Cherokee, Springfield, MO 65804 | 2016-05-25 |
| Find all providers in zip 65804 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487958112 | Carol Kim | Dentist | 3842 S Glenstone Ave, Springfield, MO 65804-4418 | 2011-01-11 |
| 1235322108 | Glen H Petteway | Dentist | 1200 E Woodhurst, Ste T300, Springfield, MO 65804-3784 | 2007-08-23 |
| 1356700181 | Glen H Petteway, D.d.s., P.C. | Dentist | 1200 E Woodhurst Dr, Bld T, Suite 300, Springfield, MO 65804-4261 | 2016-02-22 |
| 1841404019 | Kevin D Wallace Dmd, PC | Dentist | 1200 E Woodhurst Dr, Suite 200-a, Springfield, MO 65804-4257 | 2007-05-09 |
| 1205944105 | Robert Lee Swords | Dentist | 618 N Benton Ave, Springfield, MO 65806-1102 | 2006-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629605019 | Bhavika V Thakkar | Dentist | 650 E 25th St Rm 277, Kansas City, MO 64108-2716 | 2020-03-25 |
| 1285159004 | C. Alan Mcquigg Dds Ms PC | Dentist | 620 W 32nd St Ste C, Joplin, MO 64804-2528 | 2017-08-14 |
| 1770011926 | Azadeh Afshari, Dds LLC | Dentist | 517 S Euclid Ave Bldg Ste 819, Saint Louis, MO 63110-1007 | 2017-06-01 |
| 1881899466 | Warren Henry Speiser | Dentist | 885 St Francois Street, Florissant, MO 63031-4923 | 2007-06-15 |
| 1134282023 | Kristine Kae Schrock | Dentist | 3906 Sherman Ave, Saint Joseph, MO 64506-3648 | 2006-12-19 |
| 1487740189 | Kyle Donahue | Dentist | 2020 Bluestone Dr, Saint Charles, MO 63303-5974 | 2006-10-04 |
| 1093738858 | Richard Blustein | Dentist | 711 N New Ballas Rd, Saint Louis, MO 63141-6715 | 2006-07-25 |
| 1265479885 | Donna N Deines | Dentist | 203 E 63rd St, Kansas City, MO 64113-2224 | 2006-06-01 |
| 1669443990 | Timothy Scott Bartlett | Dentist | 1497 N Business Route 5, Camdenton, MO 65020-2636 | 2006-01-26 |
| 1841629557 | Clarence Elrod | Dentist | 650 E 25th St, School of Dentistry, Kansas City, MO 64108-2716 | 2013-11-03 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 65804 |
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| 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.