Mark C. Wallace, DDS
NPI 1104047190ActiveIndividual· Dentist, General Practice· Saint Paul, MN
Opted out of Medicare from January 2017 to January 2027. Dentist, General Practice (DDS) in Saint Paul, Minnesota, licensed in MN and WA, with an NPI issued in May 2007. Part D covered 95 prescriptions written in 2024, 99% of them generic. Septodont Inc. reported $108.18 in payments in 2024, mostly speaking and faculty fees.
Overview
| NPI | 1104047190 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DDS |
| Sole proprietor | No |
| NPI issued | May 1, 2007 |
| Last updated in NPPES | Jun 25, 2012 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | D12888 | MN |
| Dentist, General Practice | 1223G0001X | 5919 | WA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|---|
| Opt-out | Opted out Jan 2, 2017 – Jan 2, 2027 |
| Can order and refer | Yes |
During an opt-out period the provider sees Medicare patients only under private contracts, and Medicare does not pay claims for their services.
Part D prescriptions in 2024
| Prescriptions (claims) | 95 · 95 30-day fills |
|---|---|
| Patients | 56 |
| Total drug cost | $682.09 |
| Generic share | 99% of claims |
Industry payments (Open Payments)
- 2024$108.18 · 2 payments from 1 company
Top paying companies in 2024
| Company | Amount | Payments |
|---|---|---|
| Septodont Inc. | $108.18 | 2 |
What the 2024 payments were for
- Compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program$108.18 · 2 payments
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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All 169 general dentists in Saint Paul · All general dentists in Minnesota