Active NPI
Dawn Spruill Wallace, DDS
- General Practice Dentistry
- Charlotte, NC
National Provider Identifier
1093814535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7191
- Practice address
- 8401 University Executive Drive
Suite 110
Charlotte, NC 28262-1360 - Phone
- (704) 547-1970
- Fax
- (704) 547-1926
- NPI assigned
- Sep 21, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7191 | NC | Primary |
Addresses
Primary practice location
8401 University Executive Drive
Suite 110
Charlotte, NC 28262-1360
Mailing address
8401 University Executive Parkway
Suite 110
Charlotte, NC 28262
Phone (704) 547-1970
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7191 | Other | NC | NC LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093814535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8401 UNIVERSITY EXECUTIVE PARKWAY",
"address_2": "SUITE 110",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28262",
"telephone_number": "704-547-1970",
"fax_number": "704-547-1926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8401 UNIVERSITY EXECUTIVE DRIVE",
"address_2": "SUITE 110",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282621360",
"telephone_number": "704-547-1970",
"fax_number": "704-547-1926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DAWN",
"middle_name": "SPRUILL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "7191",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC LICENSE",
"identifier": "7191",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.