| NPI | 1205020286 |
|---|---|
| Professional Name | STEPHEN LEON WALLACE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TN ds0000004001) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2007-08-31 |