Deanne Wallaert, PHDHP

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

PHDH000393 Issued in PA

Practice address

1207 Chestnut St 4TH FL
Philadelphia, PA 19107-4131

Phone

(215) 525-3046

Fax

(215) 567-1617

NPI assigned

May 29, 2019

Last updated

May 29, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Philadelphia Fight

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1487082608
  NPD (past)
• Philadelphia Fight

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1760507859
  NPD (past)

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559088000000",
    "number": "1083271704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 LOCUST ST 3RD FL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075400",
            "telephone_number": "215-985-4448",
            "fax_number": "215-985-4952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 CHESTNUT ST 4TH FL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074131",
            "telephone_number": "215-525-3046",
            "fax_number": "215-567-1617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLAERT",
        "first_name": "DEANNE",
        "name_prefix": "Ms.",
        "credential": "PHDHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "PA",
            "license": "PHDH000393",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "PA",
            "license": "DH069570",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Elizabeth Wallace, MD
• Paul Wallace, M.D.
• Rasheada Lynn Wallace, (CD,PCD)
• Ruby M Wallace, RPH
• Eliot M Wallack, MD
• Jessica Wallauer, PHARMD
• Selemon Mulualem Walle, M.D.
• Lisa Barbara Wallenstein, M.D.
• Evelyn Waller
• Shaelyn Davis Waller, MSN, CPNP-AC, CHPPN

• Public Health Dentistry in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Public Health Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; 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.