Wally T. Austelle III, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2473 Issued in SC

Practice address

839 Wappoo Rd
Charleston, SC 29407

Phone

(843) 556-4746

Fax

(843) 556-5435

NPI assigned

Sep 30, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Care of Charlestown PA

  • Dentist
  • Charleston, SC
  • NPI 1003894866
  NPD (past)
• Peninsula Dentistry Wappoo LLC

  • Dental Clinic/Center
  • Charleston, SC
  • NPI 1376306878
  NPD (past)

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317340800000",
    "number": "1124302773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "839 WAPPOO RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29407",
            "telephone_number": "843-556-4746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "839 WAPPOO RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "29407",
            "telephone_number": "843-556-4746",
            "fax_number": "843-556-5435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AUSTELLE",
        "first_name": "WALLY",
        "middle_name": "T.",
        "name_suffix": "III",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-30",
        "last_updated": "2011-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "2473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Elizabeth Augustine
• Rubin Aujla, MD
• Rebekah H Aultman, MD
• Jami Auslander, PA-C
• Cathryn Moss Austelle, M.A., CCC-SLP
• Brittany Austin, MD
• John Edward Austin, OTR/L,CHT
• Katherine Carew Austin, OTD, OTR/L
• Linda Smith Austin, MD
• Star Austin, AG-NP

• Dentist in Charleston, SC
• Providers in Charleston, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.