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

Dr. Michael J Wallace, DDS

Individual provider Dentist · NPI 1417014424

Dr. Michael J Wallace, DDS is a Dentist in Edmond, Oklahoma. Practices as a sole proprietor. Licensed in Oklahoma.

Licensed in
OK
In the registry since
2007
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

1617 E Danforth Rd
Edmond, OK 73034-3103
Phone: (405) 340-0411
Fax: (405) 340-3217
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 5801 (OK)

Record details

NPI number1417014424
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedJanuary 2, 2007
Last updated in NPPESJanuary 28, 2021
Certification dateJanuary 26, 2021
Mailing address1617 E Danforth Road, Edmond, OK 73034-6622

Other providers in Edmond