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

McKenzie Wallace, STUDENT

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1194429597

McKenzie Wallace, STUDENT is a Student in an Organized Health Care Education/Training Program in Saint Paul, Minnesota. Licensed in Minnesota. Registered with an NPI since 2023.

Licensed in
MN
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

1026 7th St W
Saint Paul, MN 55102-3828
Phone: (651) 758-9500
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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 D14879 (MN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1194429597
Entity typeIndividual (Type 1)
GenderMale
Credentials STUDENT
Sole proprietorNo
NPI enumeratedMarch 29, 2023
Last updated in NPPESMay 25, 2023
Certification dateMay 25, 2023
Mailing address1026 7th St W, Saint Paul, MN 55102-3828

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