Matthew Tyler Wall, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DGD.9871GD Issued in SC

Practice address

174 Crepe Myrtle Dr
Aiken, SC 29803-7543

Phone

(803) 641-3883

NPI assigned

Feb 17, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Kevin G. Eubanks, D.M.D

  • Dental Clinic/Center
  • Aiken, SC
  • NPI 1013435429
  NPD (past)

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

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1083247209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "174 CREPE MYRTLE DR",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037543",
            "telephone_number": "803-641-3883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 CREPE MYRTLE DR",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298037543",
            "telephone_number": "803-641-3883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "MATTHEW",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-17",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN016114",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "DGD.9871GD",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Donmonique Nicole Walker
• Lasaundria Janai Walker, LPC
• Mackie J Walker Jr., DPM
• Maurice Shekeil Wallace
• Annie Walters
• Annie Wang
• Jing Wang, M.D.
• Afsar M Waraich, MD

• General Practice Dentistry in Aiken, SC
• Providers in Aiken, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; 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.