Carole A Wallace, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019148 Issued in NJ

Practice address

82 Bridge Ave
Red Bank, NJ 07701-1160

Phone

(732) 530-2662

NPI assigned

May 22, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043429368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 WINDSOR DR",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077242165",
            "telephone_number": "732-389-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 BRIDGE AVE",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011160",
            "telephone_number": "732-530-2662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CAROLE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "019148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miles Wagman, MSW, LCSW, LMFT
• Melinda Wagner, DMD
• Dennis Waite, PT, DPT, CSCS
• Walgreen Co
• Walgreen Co .
• Jasmine Alicia Wallace, B.S.
• Edna Ruth Walsh, MSW LCSW
• Elizabeth Dianne Walter, LCSW
• Shannon Wanless, FNP- BC
• Megan Washburn

• General Practice Dentistry in Red Bank, NJ
• Providers in Red Bank, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.