Andrew Walls, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D7828 Issued in OR

Practice address

628 N 1St St
Lakeview, OR 97630-1506

Phone

(888) 468-0022

Fax

(541) 504-3907

NPI assigned

Jun 21, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• WA PPO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advantage Dental

  • Preferred Provider Organization
  • Bend, OR
  • NPI 1285007807
  NPD (past)
• Gary Dehm, DMD

  • Dental Clinic/Center
  • Madras, OR
  • NPI 1548434608
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1043216567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 SW UMATILLA AVE",
            "address_2": "SUITE 200",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977567039",
            "telephone_number": "541-504-3900",
            "fax_number": "541-504-3907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "628 N 1ST ST",
            "city": "LAKEVIEW",
            "state": "OR",
            "postal_code": "976301506",
            "telephone_number": "888-468-0022",
            "fax_number": "541-504-3907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OK",
            "license": "5630",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1305630",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Patricia Theall, PMHNP-BC
• Kylie Thomas, MAED
• Unanimous Chiropractic, PC
• Lindsey Underhill
• Tiffany Marie Vale, QMHA CASE MANAGER
• Brandi Weatherman
• Kyrie Weaver
• Bianca A Wilson
• Coby Wilson
• Daniel Noe Zuniga III

• Dentist in Lakeview, OR
• Providers in Lakeview, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.