Wallace, George Marvin
Wallace, George Marvin is an sole proprietor health care provider with primary practice located at 710 N Elm St , High Point NC 27262-3918. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Wallace, George Marvin can be contacted via phone (336) 882-4181.Contact Information
Primary practice address
710 N Elm St
High Point NC 27262-3918
Phone: (336) 882-4181
Fax: (336) 464-2166
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 3016 | North Carolina |
Profile Details
| NPI number | 1063559748 |
|---|---|
| LBN Legal business name | Wallace, George Marvin |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 31st, 2007 |
| Last updated | Apr 25th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063559748 | NPPES |
| North Carolina | Other | 3016 | STATE LICENSE # |
| North Carolina | MEDICAID | 8998840 | STATE LICENSE # |
| North Carolina | Other | 56-0814633 | STATE LICENSE # |
| North Carolina | Other | 1063559748 | STATE LICENSE # |
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