George Marvin Wallace, D. D. S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3016 Issued in NC

Practice address

710 N Elm St
High Point, NC 27262-3918

Phone

(336) 882-4181

Fax

(336) 464-2166

NPI assigned

Jan 31, 2007

Last updated

Apr 25, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

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": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1063559748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N ELM ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272623918",
            "telephone_number": "336-882-4181",
            "fax_number": "336-464-2166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N ELM ST",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272623918",
            "telephone_number": "336-882-4181",
            "fax_number": "336-464-2166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GEORGE",
        "middle_name": "MARVIN",
        "name_prefix": "Dr.",
        "credential": "D. D. S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "3016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "3016",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8998840",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "56-0814633",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI #",
            "identifier": "1063559748",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Rite Aid)
• Walgreen Co (Rite Aid)
• John J. Walker, MD
• Kailey Rachel Walker
• Terri L Walker, CRNA
• Melanie E Wallace
• Tyshaundra Renee Wallace, M.ED, LCASA, QP
• Kenneth Wallmeyer, MD
• Johnette Walser, LCSWA
• Yun Wang

• General Practice Dentistry in High Point, NC
• Providers in High Point, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; 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.