Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark Charles Wallace, DDS, PC

Organization General Practice Dentistry · NPI 1184046385

Mark Charles Wallace, DDS, PC is a General Practice Dentistry in Minneapolis, Minnesota. Registered with an NPI since 2014.

In the registry since
2014
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3909 Silver Lake Rd NE
Minneapolis, MN 55421-4352
Phone: (612) 789-3573
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1184046385
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Rebecca Kipp — Office Manager · (612) 789-3573
Other names Advanced Dental Group
NPI enumeratedJanuary 8, 2014
Last updated in NPPESJanuary 8, 2014
Mailing address3909 Silver Lake Rd Ne, Minneapolis, MN 55421-4352

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