Charles E Wallace, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5882 Issued in WA

Practice address

3221 Eastlake Ave E Ste 130
Seattle, WA 98102-7125

Phone

(206) 633-5100

Fax

(206) 633-3667

NPI assigned

Nov 15, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dr. Charles Wallace, DDS, PS

  • General Practice Dentistry
  • Seattle, WA
  • NPI 1962539114
  NPD (past) Authorized official

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063584746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3221 EASTLAKE AVE E STE 130",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981027125",
            "telephone_number": "206-633-5100",
            "fax_number": "206-633-3667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3221 EASTLAKE AVE E STE 130",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981027125",
            "telephone_number": "206-633-5100",
            "fax_number": "206-633-3667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "5882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Wallace Stewart, LMHC
• Annabel Wallace, NP
• Betsy Katrina Wallace, LMP
• Carol A Wallace
• Catherine Maria Caska Wallace, PH.D.
• Chris C Wallace, LMP
• Cynthia Kay Wallace, MD
• Denise Eileen Wallace, LMHC
• Elliot Wallace, M.S.
• Erin Elizabeth Wallace, LMP

• General Practice Dentistry in Seattle, WA
• Providers in Seattle, WA by specialty
• General Practice Dentistry in Washington

• 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.
• 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.