Wallace Periodontics, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WALLACE PERIODONTICS, LLC

Practice address

3 Professional CT
Sumter, SC 29150-1927

Phone

(803) 294-4021

NPI assigned

Sep 15, 2026

Organization subpart

No

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

Authorized official

Name

Casey Castle

Title

Director of Payor Contracts

Phone

(912) 732-1504

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1789430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789430400000",
    "number": "1164333555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL CT",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291501927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL CT",
            "city": "SUMTER",
            "state": "SC",
            "postal_code": "291501927",
            "telephone_number": "803-294-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE PERIODONTICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-15",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A",
        "authorized_official_last_name": "CASTLE",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "DIRECTOR OF PAYOR CONTRACTS",
        "authorized_official_telephone_number": "912-732-1504"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #09276)
• Walgreen Co (Rite Aid)
• Walgreen Co (Rite Aid)
• Terrance Walker, PH.D.
• Marshall Lynn Wallace, DMD
• Marissa Wallin, PHARMD
• Teresa Walls, LPN
• Deli Wang, M.D.
• Sara Wanner, LDO

• Dental Clinic/Center in Sumter, SC
• Providers in Sumter, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; 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.