Active NPI
Wallace Bruce Meikle, DDS
- Dentist
- Barstow, CA
National Provider Identifier
1114255569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 27339
- Practice address
- 301 E Buena Vista St
Barstow, CA 92311-2803 - Phone
- (176) 025-6596
- Fax
- (176) 025-6185
- NPI assigned
- Nov 23, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 27339 | CA | Primary |
Addresses
Primary practice location
301 E Buena Vista St
Barstow, CA 92311-2803
Mailing address
301 E Buena Vista St
Barstow, CA 92311-2803
Phone (176) 025-6596
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27339 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258934400000",
"number": "1114255569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 E BUENA VISTA ST",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923112803",
"telephone_number": "176-025-6596",
"fax_number": "176-025-6185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E BUENA VISTA ST",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923112803",
"telephone_number": "176-025-6596",
"fax_number": "176-025-6185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEIKLE",
"first_name": "WALLACE",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-23",
"last_updated": "2009-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "27339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Barstow, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.