Sarah Ade Wallace, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019028357 Issued in IL

Practice address

7017 John Deere Parkway - Suite 2B
Moline, IL 61265

Phone

(309) 792-0513

Fax

(309) 792-0534

NPI assigned

Jun 29, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Sarah Lynn Ade Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Parkway View Family Dentistry LTD

  • General Practice Dentistry
  • Moline, IL
  • NPI 1154451847
  NPD (past)

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1164733762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7017 JOHN DEERE PARKWAY- SUITE 2B",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "309-792-0513",
            "fax_number": "309-792-0534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7017 JOHN DEERE PARKWAY - SUITE 2B",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "61265",
            "telephone_number": "309-792-0513",
            "fax_number": "309-792-0534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SARAH",
        "middle_name": "ADE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-29",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019028357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARAH",
            "last_name": "ADE",
            "middle_name": "LYNN",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walgreen Co (Walgreens #06067)
• Walgreen Co. (Walgreens #5720)
• Walgreen Co. (Walgreens #3633)
• Walgreen Co. (Walgreens #6067)
• Harry L. Wallace, D.C.
• Harry R Wallner, M.D.
• Walmart Inc.
• Ginger Ward, RN, BSN-BC
• Jean E Wardlow, MD
• Kareem Washington

• Oral and Maxillofacial Surgery (Dentist) in Moline, IL
• Providers in Moline, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.