Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1417014424 Individual Practitioner Male Practitioner

Dr. Michael J Wallace , DDS

Dentist • Edmond, OK

Professional Overview & Biography Verified Profile Summary

Dr. Michael Wallace, DDS is a registered healthcare professional specializing in Dentist in Edmond, OK. Practice services are available at 1617 E DANFORTH RD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

1617 E Danforth Rd

Edmond, OK 730343103

Telephone 4053400411
Fax 4053403217
Associated Practice Facility / Clinic
🏢 Philip M Gray, Dds, Pllc Facility NPI 1134845712

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Edmond, OK

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 11.6 Yrs
Regional Practice Density
36 Specialists

Practicing in Edmond, OK (1115 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2021-01-26
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License OK 5801

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: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
200066490 A (OK)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Kayla-Ann Nittler

Dentist - General Practice

NPI 1386375137

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location January 28, 2021

Registered at 1617 E DANFORTH RD, EDMOND, OK 730343103 (Tel: 4053400411)

📍
Updated Business Mailing Address January 28, 2021

Registered at 1617 E DANFORTH ROAD, EDMOND, OK 730346622 (Tel: 4053400411)

NPI Profile Active July 09, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 09, 2007

Registered at 1600 E 19TH ST, SUITE 301, EDMOND, OK 730136622 (Tel: 4053400411)

📍
Updated Business Mailing Address July 09, 2007

Registered at 1600 E 19TH ST, SUITE 301, EDMOND, OK 730136622 (Tel: 4053400411)

👤
Provider Name / Credentials Updated July 09, 2007

Recorded as MICHAEL WALLACE, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 09, 2007

Dentist (License #5801 in OK)

🟢
Initial NPI Registration & Enumeration January 02, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1417014424
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 02, 2007
Last Update: January 28, 2021
Sole Proprietor: Yes

Mailing Address

1617 E Danforth Road

Edmond, OK 730346622

Phone: 4053400411

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.