Dr. Michael J Wallace, DDS
Dr. Michael J Wallace is a Dentist provider (Dentist) practicing in Edmond, OK, registered in the NPPES registry with NPI 1417014424 since 2007. The credential DDS stands for Doctor of Dental Surgery. Practices at Philip M Gray, DDS, Pllc (listed at the same practice address in NPPES).
✓ Active NPI ✓ Valid NPI checksum Sole proprietor
| NPI | 1417014424 |
|---|---|
| Entity type | Individual (Type 1) |
| Name | Dr. Michael J Wallace |
| Credential | DDS |
| Sex | Male |
| Practice address | Edmond, OK, 73034 |
| Phone | 4053400411 |
| Fax | 4053403217 |
| Enumeration date | 2007-01-02 |
| Last updated in NPPES | 2021-01-28 |
Street address withheld — NPPES sole-proprietor addresses can be home addresses. See our data policy.
Taxonomy & licenses
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 122300000X | Dentist | Primary | 5801 | OK |
DDS — Doctor of Dental Surgery: A licensed dentist; DDS and DMD are equivalent dental degrees. About the DDS credential
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200066490 A | Medicaid | OK | — |
Copy-ready billing details
Provider: Michael Wallace, DDS NPI: 1417014424 Taxonomy: 122300000X (Dentist) Address: Edmond, OK, 73034
Other providers at this practice address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1386375137 | Kayla-Ann Nittler | Individual | General Practice Dentistry | Edmond, OK |
| 1134845712 | Philip M Gray, DDS, Pllc | Organization | Dental Clinic/Center | Edmond, OK |
Verify this record
Cross-check NPI 1417014424 against the authoritative CMS record: view Dr. Michael J Wallace on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
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Is NPI 1417014424 active?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2021-01-28.