Matthew H Wallengren, DDS, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12462 Issued in MD

Practice address

1421 Clarkview Rd Ste 120
Baltimore, MD 21209-2187

Phone

(410) 431-1868

NPI assigned

Nov 3, 2006

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 PA

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

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1154400877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 CLARKVIEW RD STE 120",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092187",
            "telephone_number": "410-431-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 CLARKVIEW RD STE 120",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212092187",
            "telephone_number": "410-431-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENGREN",
        "first_name": "MATTHEW",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DDS, PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "12462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trezure Wallace
• Ty'Cristian Q. Wallace, LGPC, CAC-ADS
• Zachary Wallace
• Sara Wallam, MD
• Jana Wallen
• Ami C. Waller
• Jessica Price D'Argenio Waller, M.S., C.N.S., L.D.N.
• Sheila Waller, CRNP
• Jeremy Wallick, DPT
• Jo Lynne Wallin-Wais, PHARM.D., BCPS

• General Practice Dentistry in Baltimore, MD
• Providers in Baltimore, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2025; 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.