Shernique Wallace, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

33849 Issued in TX

Practice address

8330 Long Point Rd
Houston, TX 77055

Phone

(713) 461-4770

NPI assigned

Mar 27, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

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.

• Brident Dental Associates PC

  • Dentist
  • Houston, TX
  • NPI 1053884148
  NPD (past)
• Brident Dental Associates PC

  • Dentist
  • Houston, TX
  • NPI 1245703339
  NPD (past)
• Brident Dental Associates PC

  • Dentist
  • Houston, TX
  • NPI 1528531605
  NPD (past)
• South Texas Dental Associates, L.P.

  • General Practice Dentistry
  • Houston, TX
  • NPI 1497973895
  NPD (past)
• South Texas Dental Associates, L.P.

  • General Practice Dentistry
  • Houston, TX
  • NPI 1689892085
  NPD (past)
• South Texas Dental Associates, L.P.

  • General Practice Dentistry
  • Houston, TX
  • NPI 1881812287
  NPD (past)

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559779200000",
    "number": "1073907960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 S POST OAK LN APT 1416",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770562268",
            "telephone_number": "718-724-4869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8330 LONG POINT RD",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77055",
            "telephone_number": "713-461-4770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Ashland Pl",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112015401",
            "country_code": "US",
            "telephone_number": "718-724-4869",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 E Crosstimbers St Ste B",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "77022",
            "country_code": "US",
            "telephone_number": "713-692-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 E Crosstimbers St Ste B",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "77022",
            "country_code": "US",
            "telephone_number": "713-692-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1400 Pelham Pkwy S",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104611138",
            "country_code": "US",
            "telephone_number": "718-724-4869",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12052 East Fwy",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "77029",
            "country_code": "US",
            "telephone_number": "713-451-5700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12052 East Fwy",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770291916",
            "country_code": "US",
            "telephone_number": "713-451-5700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SHERNIQUE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-27",
        "last_updated": "2019-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": "059085-1",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "33849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Ann Wallace, MSW
• Rebekah Wallace, LCSW
• Shannon E Wallace
• Sharon Renee Wallace, MD
• Shawnee Wallace, DO
• Sowdhamini Shettigar Wallace, D.O.
• Stephanie Wallace, MS, CGC
• Rebecca Burditt Walle, RN
• Wayne Wallen, D.C
• Waller Medical Clinic, P.a.

• General Practice Dentistry in Houston, TX
• Providers in Houston, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2019; 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.