Kevin R Wallace is a Dentist in Lockport, Illinois. Kevin R Wallace practices all healthcare services and medical treatments related to Dentist. The NPI Number for Kevin R Wallace is 1053423285. The last update date is 2021-01-19.
Kevin R Wallace's current location address is 14831 W 159th St Ste 1, Lockport, Illinois. You can contact this provider via phone number 6303245369 and fax number 8157447059. The mailing address for Kevin R Wallace is 14831 W 159th St Ste 1, Lockport, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kevin R Wallace |
|---|---|
| Address | 14831 W 159th St Ste 1, Lockport, Illinois |
| Phone Number | 6303245369 |
| Fax Number | 8157447059 |
| Sole Proprietor | N |
| Credentials | DMD |
NPI Number Detail
| NPI Number | 1053423285 |
|---|---|
| Provider Enumeration Date | 2006-09-01 |
| Last Updated Date | 2021-01-19 |
Provider Mailing Address Detail
| Address | 14831 W 159th St Ste 1 |
|---|---|
| City | Lockport |
| State | Illinois (IL) |
| Post Code | 604919008 |
| Phone Number | 6303245369 |
| Fax Number | 8157447059 |
Provider's Primary Taxonomy Detail
| Speciality | Dentist |
|---|---|
| Taxonomy | 122300000X |
| Licence No | 19022339 |
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Definition: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: denti |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1053431981 | IL | GROUP TYPE II NPI | |
| 1306177241 | IL | PRACTICE LOCATION TYPE II NPI | |
| 1205145554 | IL | PRACTICE LOCATION TYPE II NPI | |
| 1508198474 | IL | PRACTICE LOCATION TYPE II NPI | |
| 1760882005 | IL | PRACTICE LOCATION TYPE II NPI | |
| 1295165439 | IL | PRACTICE LOCATION TYPE II NPI | |
| 019-022339 | IL | DENTAL-IL | |
| 1063649770 | IL | GROUP TYPE II NPI |
Post Comment/ Review Below
What is the unique identification code assigned to Kevin R Wallace by the Centers for Medicare & Medicaid Services?
The Kevin R Wallace has been issued the NPI (National Provider Identifier) 1053423285. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Kevin R Wallace?
The Kevin R Wallace is situated at 14831 W 159Th St Ste 1, in the city of Lockport, state of IL, with the zip code 604919008.
What is Kevin R Wallace's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Kevin R Wallace is Dentist, and the corresponding taxonomy classification code for this specialized field is 122300000X.
On what date did the Kevin R Wallace receive its 1053423285 assignment from the Centers for Medicare & Medicaid Services?
The Kevin R Wallace was assigned its 1053423285 by the Centers for Medicare & Medicaid Services on 2006-09-01.
As of what date was the information regarding Kevin R Wallace, such as address, specialty, and other details, last verified and confirmed to be up-to-date?
The information related to Kevin R Wallace, including its address, specialty, and other relevant details, was last verified and confirmed to be up-to-date on 2021-01-19.
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