NPIMap

Organization Active NPI

James M. Walter, Jr, DDS, Ms, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Winston Salem, NC
National Provider Identifier
1124070222
Registry record updated Nov 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
4128 Issued in NC
Legal business name
JAMES M. WALTER, JR, DDS, MS, PA
Practice address
3020 Maplewood Avenue
Winston Salem, NC 27103
Phone
(336) 768-9881
Fax
(336) 768-6066
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2012

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

Authorized official

Name
Dr. James M Walter Jr., DDS MS
Title
Owner
Phone
(336) 768-9881

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0106X NC
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 4128 NC Primary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 7036 NC

Addresses

Primary practice location

3020 Maplewood Avenue
Winston Salem, NC 27103

Mailing address

3020 Maplewood Avenue
Winston Salem, NC 27103
Phone (336) 768-9881

Other identifiers 1

IdentifierTypeStateIssuer
890191NMedicaidNC

National Provider Directory

National Provider Directory

Locations

3020 Maplewood Ave
Winston Salem, NC 27103
Phone (336) 768-9881

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352851200000",
    "number": "1124070222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 MAPLEWOOD AVENUE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-768-9881",
            "fax_number": "336-768-6066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 MAPLEWOOD AVENUE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27103",
            "telephone_number": "336-768-9881",
            "fax_number": "336-768-6066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES M. WALTER, JR, DDS, MS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-11-14",
        "status": "A",
        "authorized_official_last_name": "WALTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-768-9881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS MS"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "4128",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "7036",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890191N",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2012; 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.