Active NPI
Michelle Anne Wall, D.D.S.
- General Practice Dentistry
- Hemet, CA
National Provider Identifier
1104081447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 57243
- Practice address
- 255 N Gilbert St
Suite C2
Hemet, CA 92543-4066 - Phone
- (951) 766-4211
- NPI assigned
- Jul 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 57243 | CA | Primary |
Addresses
Primary practice location
255 N Gilbert St
Suite C2
Hemet, CA 92543-4066
Mailing address
255 N Gilbert St
Suite C2
Hemet, CA 92543-4066
Phone (951) 766-4211
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": "1216944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216944000000",
"number": "1104081447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 N GILBERT ST",
"address_2": "SUITE C2",
"city": "HEMET",
"state": "CA",
"postal_code": "925434066",
"telephone_number": "951-766-4211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 N GILBERT ST",
"address_2": "SUITE C2",
"city": "HEMET",
"state": "CA",
"postal_code": "925434066",
"telephone_number": "951-766-4211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "MICHELLE",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-25",
"last_updated": "2008-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "57243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hemet, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.