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DR. MICHAEL J WALLACE DDS
NPI 1417014424
Dentist in Edmond, OK

Active since January 02, 2007PECOS Enrolled
1617 E DANFORTH RD, EDMOND, OK 73034(405) 340-0411(405) 340-3217 Get Directions Write a Review

NPPES record last updated: January 28, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Michael J Wallace Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MICHAEL J WALLACE DDS (NPI 1417014424) is an individual dentist in Edmond, Oklahoma, licensed in Oklahoma (5801) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1417014424
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. MICHAEL J WALLACECredential: DDS
Location Address1617 E DANFORTH RDEdmond, OK 73034-3103
Mailing Address1617 E Danforth RoadEdmond, OK 73034-6622 · (405) 340-0411 · Fax (405) 340-3217
Phone(405) 340-0411
Fax(405) 340-3217
Sole ProprietorYes
Enumeration DateJanuary 2, 2007
Last NPPES UpdateJanuary 28, 2021
NPPES CertifiedJanuary 26, 2021
✔ NPI 1417014424 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in OK · 5801
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
1617 E DANFORTH RD, Edmond, OK 73034
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Other Identifiers 1

Medicaid200066490 AOK

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Michael J Wallace Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 73034 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.46 typical visit price
range $53.00 – $162.61
Typical copayment $20.61 (range $13.25 – $40.65)
Most-billed visit code 99203
Established Patient
$66.48 typical visit price
range $16.68 – $132.40
Typical copayment $16.62 (range $4.17 – $33.10)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PHILIP M GRAY, DDS, PLLC
Clinic/Center (Dental)
1617 E DANFORTH RD
EDMOND, OK 73034
Oklahoma County (405) 330-5458
KAYLA-ANN NITTLER
Dentist (General Practice)
1617 E DANFORTH RD
EDMOND, OK 73034
Oklahoma County (405) 330-5458

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Wallace's NPI number?

The NPI number for Michael Wallace is 1417014424. It was assigned to this individual provider in the NPPES registry on January 2, 2007.

Where is Michael Wallace located?

Michael Wallace practices at 1617 E Danforth Rd, Edmond, OK 73034. The listed phone number is (405) 340-0411.

What is Michael Wallace's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Michael Wallace enrolled in Medicare?

Yes. Michael Wallace is registered in the Medicare PECOS enrollment system.

What insurance does Michael Wallace accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Alabama, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Michael Wallace as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Michael Wallace was last updated on January 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.