Wayne Carroll Wallace, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19098 Issued in OH

Practice address

3972 Red Bank Rd
Suite E
Cincinnati, OH 45227-3425

Phone

(513) 561-9900

Fax

(513) 561-9902

NPI assigned

Feb 5, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Locations

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.

• Mobile Medical Inc

  • Optometrist
  • Perrysburg, OH
  • NPI 1689620015
  Medicare reassignment NPD
• Mobile Medical, Inc.

  • Podiatrist
  • Perrysburg, OH
  • NPI 1003066747
  NPD
• Mobile Medical, Inc.

  • Dentist
  • Perrysburg, OH
  • NPI 1629228572
  NPD

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415232000000",
    "number": "1154460459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3972 RED BANK RD",
            "address_2": "SUITE E",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452273425",
            "telephone_number": "513-561-9900",
            "fax_number": "513-561-9902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3972 RED BANK RD",
            "address_2": "SUITE E",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452273425",
            "telephone_number": "513-561-9900",
            "fax_number": "513-561-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WAYNE",
        "middle_name": "CARROLL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2014-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "19098",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0815854",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nikki Wallace, LPN
• Olivia Wallace, BA
• Robert P. Wallace, M.D.
• Sanchez Wallace
• Waymon L Wallace, MD
• Yashauna Wallace, LISW
• Yvonne Sue Wallace, LPN
• Elizabeth Wallbrown
• Taylor Elaine Wallen, MD
• Allison Wallenhorst, APRN, BC-WHNP

• General Practice Dentistry in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; 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.