Deanna T Wallace, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

5054-16 Issued in WI

Practice address

1344 Creston Park Dr Ste 2
Janesville, WI 53545-1113

Phone

(608) 314-1940

NPI assigned

Jun 28, 2021

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

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15975/brand/1/csg/1/fhir/r4

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.

• Healthnet of Rock County, Inc.

  • Dentist
  • Janesville, WI
  • NPI 1205285699
  NPD (past)

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1043880438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 W MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482981",
            "telephone_number": "608-314-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 CRESTON PARK DR STE 2",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535451113",
            "telephone_number": "608-314-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DEANNA",
        "middle_name": "T",
        "credential": "RDH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "WI",
            "license": "5054-16",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Heather Renee Walker, RDH
• Laura L. Walker, PT
• Margot R. Walker, APRN, WHNP-BC
• Jessica A. Wallace, APRN, PMHNP
• Andrew Wallner, DPT
• Kevin B Walter, OD
• Hailey Anne Walters, RN
• Kathryn Ree Walters, OT

• Dental Hygienist in Janesville, WI
• Providers in Janesville, WI by specialty
• Dental Hygienist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.