Wallace, Marshall Lynn

Wallace, Marshall Lynn is an individual health care provider with primary practice located at 3 Professional Ct , Sumter SC 29150-1927. He recently has only one registered license in Dental Providers / Periodontics, which is considered as his primary health care specialty. Wallace, Marshall Lynn can be contacted via phone (803) 469-9461.

Contact Information

Primary practice address
3 Professional Ct Sumter SC 29150-1927
Phone: (803) 469-9461
Fax: (803) 469-9023
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Periodontics 1223P0300X 2839/363 South Carolina

Profile Details

NPI number 1124092697
LBN Legal business name Wallace, Marshall Lynn
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124092697 NPPES
South Carolina MEDICAID ZA9760

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