IndividualActive
Patrick Wallace, D.D.S.
NPI 1508857053 · Oral and Maxillofacial Surgery (Dentist) · Ardmore, OK
Provider details
- NPI number
- 1508857053
- Entity type
- Individual
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- No
- License
- 4988 (OK)
Specialties & taxonomies
Dental Providers
Practice location
1119 Walnut Dr
Suite 2
Ardmore, OK 73401-2360
Phone: (580) 226-1727
Fax: (580) 226-9413
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 108816
Oklahoma City, OK 73101-8816
Registry dates
- Enumerated
- 2005-11-03
- Last updated
- 2014-01-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.