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1346698842
JASON WALLACE
EDMOND, OK
NPI
1346698842
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: OK 6806)
Enumeration Date
2016-05-25
Last Update Date
2016-05-25
Business Address
Dr. JASON WALLACE D.D.S.
1400 W COVELL RD
EDMOND, OK 73003-3504
Phone number: 405-348-6161
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Mailing Address
Dr. JASON WALLACE D.D.S.
1400 W COVELL RD
EDMOND, OK 73003-3504
Phone number:
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