Wally Alessandro Garcia Fulle, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN25266 Issued in FL

Practice address

1312 Manatee Ave E
Bradenton, FL 34208-1358

Phone

(941) 708-8710

Fax

(941) 708-8761

NPI assigned

Jul 5, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Networks

• Freedom Health HMO Network

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1154817880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 8TH AVE W STE 101",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342214737",
            "telephone_number": "941-776-4000",
            "fax_number": "941-845-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 MANATEE AVE E",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342081358",
            "telephone_number": "941-708-8710",
            "fax_number": "941-708-8761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARCIA FULLE",
        "first_name": "WALLY ALESSANDRO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-05",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CT",
            "license": "12297",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN25266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerilyn Gantt
• Jennifer Lauren Garafola, LCSW
• Jacqueline Garavito, M.D.
• Dominick Christian Garbe
• Joel Garcia Boss
• Jazel Garcia Martin
• Luis Garcia Molina
• Erin Garcia, CRNA
• Getzabel Garcia, GETZABEL
• Sarah Deborah Garcia, LMHC

• General Practice Dentistry in Bradenton, FL
• Providers in Bradenton, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.