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

Dr. Kevin Bruce Wallace, DMD

Individual provider Dentist · NPI 1316960131

Dr. Kevin Bruce Wallace, DMD is a Dentist in Leesburg, Florida. Practices as a sole proprietor. Licensed in Florida.

Licensed in
FL
In the registry since
2006
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

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Practice location Address checks out

949 N 14th St
Leesburg, FL 34748-3838
Phone: (352) 816-0855
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence DN15774 (FL)

Record details

NPI number1316960131
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorYes
NPI enumeratedJuly 25, 2006
Last updated in NPPESNovember 2, 2011

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