Dr. Kevin R Wallace is a Chicago, Illinois based Dentist with
36 years of experience in
Dentistry. He completed his graduation from
Other in 1990 He is also affiliated with hospitals like
. He may accept the Medicare-approved amount. Patients may be billed for more than the Medicare deductible and coinsurance. Active license number of Dr. Kevin R Wallace is
019022339 for General Practice Dentistry in Illinois. His current practice location is
150 E Huron St, Ste 1103, Chicago. Patients can reach him at
312-676-9893.
Dr. Kevin R Wallace is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Dr. Kevin R Wallace speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
| Name: | Dr. Kevin R Wallace |
| Specialization: | Dentist |
| Gender: | Male |
| Credentials: | DMD |
| Experience: | 36+ years |
| Medical School Attended: | Other |
| Graduation Year: | 1990 |
| Accepts Medicare Assignment: | May Accept |
| Practice Address: | 150 E Huron St, Ste 1103, Chicago,
Illinois, 60611 |
| Phone: | 312-676-9893 |
| Fax: | 815-744-7059 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| PAC ID: | 1951691237 |
| Enrollment ID: | I20160620000860 |
| NPI Number: | 1053423285 |
| NPI Enumeration Date: | 01 Sep, 2006 |
| NPI Last Update On: | 19 Jan, 2021 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Kevin R Wallace are as mentioned below.
| License Number | Specialization | State | Status | |
| 019022339 | General Practice Dentistry | Illinois | Primary | |
| 019022339 | Dentistry | Illinois | Secondary | |
| 019-022339 | Dentistry | Illinois | Secondary | |
Hospital Affiliation:
Surgeons are affiliated to many hospitals whom they worked with in the past or are presently working with. One surgeon can be affiliated to four to five hospitals at a time.
| Hospital Name (CCN) | State | Hospital Type |
| (140281) | Chicago, IL | Acute Care Hospital |
Group Practice:
Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name
with which Dr. Kevin R Wallace is associated with along with the number of members in that group.
| Organization Name (Group PAC ID) | Members |
| Dental Sleep Center Richard A Craig Dds Ltd (8820287121) | 4 |
Other Medical Identifiers:
Other legacy medical identifiers associated with Dr. Kevin R Wallace such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 1053431981 | Other | Illinois | GROUP TYPE II NPI |
| 1306177241 | Other | Illinois | PRACTICE LOCATION TYPE II NPI |
| 1205145554 | Other | Illinois | PRACTICE LOCATION TYPE II NPI |
| 1508198474 | Other | Illinois | PRACTICE LOCATION TYPE II NPI |
| 1760882005 | Other | Illinois | PRACTICE LOCATION TYPE II NPI |
| 1295165439 | Other | Illinois | PRACTICE LOCATION TYPE II NPI |
| 019-022339 | Other | Illinois | DENTAL-IL |
| 1063649770 | Other | Illinois | GROUP TYPE II NPI |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 14831 W 159th St Ste 1,
Lockport, Illinois |
| Zip: | 60491-9008 |
| Phone Number: | 630-324-5369 |
| Fax Number: | 815-744-7059 |
Patients can reach Dr. Kevin R Wallace at
150 E Huron St, Ste 1103, Chicago, Illinois or can
call to book an appointment on 312-676-9893.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.