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

Dr. Kevin R Wallace, DMD

Individual provider Dentist · NPI 1053423285

Dr. Kevin R Wallace, DMD is an Oral Surgery in Chicago, Illinois. Qualified in 1990, 36 years ago. Practices with Dental Sleep Center Richard a Craig DDS Ltd, a 4-clinician group and offers telehealth. Licensed in Illinois.

Years since qualifying
36
Licensed in
IL
In the registry since
2006
Specialties on file
3
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

150 E Huron St Ste 1103
Chicago, IL 60611
Phone: (312) 676-9893
Fax: (815) 744-7059
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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 · Licence 019022339 (IL)
Dentist Taxonomy 122300000X · Licence 019022339 (IL)
Dentist Taxonomy 122300000X · Licence 019-022339 (IL)

Record details

NPI number1053423285
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD
Sole proprietorNo
NPI enumeratedSeptember 1, 2006
Last updated in NPPESJanuary 19, 2021
Certification dateJanuary 19, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyORAL SURGERY
Medical schoolOTHER
Graduated 1990 (36 years in practice)
Group practice Dental Sleep Center Richard A Craig Dds Ltd — 4 clinicians
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

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