Dr. Douglas W. Wallace
Oral & Maxillofacial Surgeon
5188 Winton Rd
Fairfield
, Ohio 45014-2900
Dr. Douglas W. Wallace
Oral & Maxillofacial Surgeon
5188 Winton Rd
Fairfield
, Ohio 45014-2900
(513) 858-4290
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About
Features
Specialties
- Oral & Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Douglas W. Wallace
- 5188 Winton Rd
- Fairfield, OH
- Zip : 45014-2900
- Fax : (513) 858-4290
- Phone : (513) 829-8080
Second Address
- Dr. Douglas W. Wallace
- 5188 Winton Rd
- Fairfield, OH
- Zip : 45014-2900
- Fax : (513) 858-4290
- Phone : (513) 829-8080
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 204E00000X | Oral & Maxillofacial Surgeon | 30-01-6806 | OH |
National Provider Identifier
| NPI | 1376698753 |
|---|---|
| Provider Name | Dr. Douglas W. Wallace |
| First Address | Fairfield, OH 45014-2900 |
| Second Address | Fairfield, OH 45014-2900 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/01/2007 |
| Last Update Date | 01/04/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| T48271 | (02) | OH |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.