Jesserwallddspa

Primary specialty

DentistTaxonomy code 122300000X

License

5098 Issued in VA

Legal business name

JESSERWALLDDSPA

Practice address

1045 Main St
Suite 6
Danville, VA 24541-1800

Phone

(434) 792-8622

NPI assigned

Apr 22, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Jesse Wall, DDS

Title

President

Phone

(434) 792-1512

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1104090067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 MAIN ST",
            "address_2": "SUITE 6",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411800",
            "telephone_number": "434-792-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 MAIN ST",
            "address_2": "SUITE 6",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411800",
            "telephone_number": "434-792-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JESSERWALLDDSPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "434-792-1512",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "5098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA BOARDOF DENTISTRY",
            "identifier": "5098",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle James, RD, LDN
• Stephan H Jannach, MD
• Nikki Renee Jefferies, PMHNP
• Cassandra Jefferson-Davis
• Amy Scearce Jennings, LPC
• John Stephen Eggleston, D.C., P.C.
• John T. Will, DDS, PLLC
• Johnnys Heroes Youth and Family Services, Inc.
• Cassandra Lynn Johnson, LCSW
• Chaderick Demond Johnson

• Dentist in Danville, VA
• Providers in Danville, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.

Verify at the official NPI Registry.