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MICHAEL PATRICK WALLACE DMD
NPI 1679585038
Dentist in Saint Louis, MO

Active since August 13, 2006Opted out of Medicare · through May 1, 2027
9225 MANCHESTER RD, SUITE 101, SAINT LOUIS, MO 63144(314) 968-0003(314) 968-0383 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Michael Patrick Wallace Dmd NPPES

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

MICHAEL PATRICK WALLACE DMD (NPI 1679585038) is an individual dentist in Saint Louis, Missouri, licensed in Missouri (13992) and active in the NPI registry since August 2006. He has opted out of Medicare through May 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1679585038
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameMICHAEL PATRICK WALLACECredential: DMD
Location Address9225 MANCHESTER RD, SUITE 101Saint Louis, MO 63144-2640
Mailing Address9225 Manchester Rd, Suite 101Saint Louis, MO 63144-2640 · (314) 968-0003 · Fax (314) 968-0383
Phone(314) 968-0003
Fax(314) 968-0383
Sole ProprietorYes
Enumeration DateAugust 13, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1679585038 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MO · 13992
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.
9225 MANCHESTER RD, Saint Louis, MO 63144
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Michael Patrick Wallace Dmd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 1, 2015 through May 1, 2027.

Opt-Out Effective DateMay 1, 2015
Opt-Out In Effect ThroughMay 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63144 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
$86.32 typical visit price
range $55.65 – $169.38
Typical copayment $21.58 (range $13.91 – $42.34)
Most-billed visit code 99203
Established Patient
$69.50 typical visit price
range $17.76 – $137.92
Typical copayment $17.37 (range $4.44 – $34.48)
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 3

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

MICHAEL P. WALLACE D.M.D., PC
Dentist (General Practice)
9225 MANCHESTER RD, SUITE 101
SAINT LOUIS, MO 63144
St. Louis County (314) 968-0003
DR. KEITH FLETCHER ANDERSON D.M.D.
Dentist
9225 MANCHESTER RD, SUITE 202
SAINT LOUIS, MO 63144
St. Louis County (314) 961-5866
DR. DANIEL ALLAN DUNBAR D.M.D., M.S.
Dentist (Endodontics)
9225 MANCHESTER RD, STE. 201
SAINT LOUIS, MO 63144
St. Louis County (314) 961-9225

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 1679585038. It was assigned to this individual provider in the NPPES registry on August 13, 2006.

Where is Michael Wallace located?

Michael Wallace practices at 9225 Manchester Rd Suite 101, Saint Louis, MO 63144. The listed phone number is (314) 968-0003.

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?

No. Michael Wallace has opted out of Medicare through May 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Michael Wallace was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.