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DR. PATRICK L WALLACE D.D.S.
NPI 1508857053
Dentist - Oral and Maxillofacial Surgery in Ardmore, OK

Active since November 03, 2005PECOS Enrolled
1119 WALNUT DR, SUITE 2, ARDMORE, OK 73401(580) 226-1727(580) 226-9413 Get Directions Write a Review

NPPES record last updated: January 13, 2014. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Patrick L Wallace D.d.s. NPPES

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

DR. PATRICK L WALLACE D.D.S. (NPI 1508857053) is an individual oral and maxillofacial surgery provider in Ardmore, Oklahoma, licensed in Oklahoma (4988) and active in the NPI registry since November 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1508857053
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameDR. PATRICK L WALLACECredential: D.D.S.
Location Address1119 WALNUT DR, SUITE 2Ardmore, OK 73401-2360
Mailing AddressPo Box 108816Oklahoma City, OK 73101-8816 · (405) 848-7974 · Fax (405) 848-0033
Phone(580) 226-1727
Fax(580) 226-9413
Sole ProprietorNo
Enumeration DateNovember 3, 2005
Last NPPES UpdateJanuary 13, 2014
✔ NPI 1508857053 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in OK · 4988
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
1119 WALNUT DR, Ardmore, OK 73401
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Other Identifiers 3

Medicare UPINU51106OK
Medicaid100119640AOK
Medicare ID-Type Unspecified245507502OK

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas 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. Patrick L Wallace D.d.s. 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 73401 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 4

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

DR. RON L GRAVES D.D.S.
Dentist (Oral and Maxillofacial Surgery)
1119 WALNUT DR, SUITE 2
ARDMORE, OK 73401
Carter County (580) 226-1727
OMS OF SOUTHERN OKLAHOMA PLLC
Dentist (Oral and Maxillofacial Surgery)
1119 WALNUT DR, 2
ARDMORE, OK 73401
Carter County (580) 226-1727
DR. JAMIE LYNN GUTHRIE DDS
Dentist (General Practice)
1119 WALNUT DR, SUITE 3
ARDMORE, OK 73401
Carter County (580) 224-9600
JAMIE L. GUTHRIE, DDS INC, P.C.
Dentist (General Practice)
1119 WALNUT DR, SUITE 3
ARDMORE, OK 73401
Carter County (580) 224-9600

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 Patrick Wallace's NPI number?

The NPI number for Patrick Wallace is 1508857053. It was assigned to this individual provider in the NPPES registry on November 3, 2005.

Where is Patrick Wallace located?

Patrick Wallace practices at 1119 Walnut Dr Suite 2, Ardmore, OK 73401. The listed phone number is (580) 226-1727.

What is Patrick Wallace's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Patrick Wallace enrolled in Medicare?

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

What insurance does Patrick Wallace accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas, Humana and Mending Health list Patrick 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 Patrick Wallace was last updated on January 13, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.