Timothy Jason Wall, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22745 Issued in TX

Practice address

4335 College Hills Blvd
San Angelo, TX 76904-6919

Phone

(214) 226-3599

NPI assigned

May 7, 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

Medicare fee-for-service enrollment

Enrolled in TX

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

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1194938100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4335 COLLEGE HILLS BLVD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046919",
            "telephone_number": "214-226-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4335 COLLEGE HILLS BLVD",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769046919",
            "telephone_number": "214-226-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "TIMOTHY",
        "middle_name": "JASON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allison J Walker, M.D.
• Jill D'Shannon Walker, CCC SLP
• Lacy Dawn Walker, OTR
• Wall Isd
• Jeffery Wall, MS
• Drew George Wallace, D.C.
• Michael Wallace
• Jamie Jean Waller
• Kelsey Walling, RD, LD, CNSC
• Margaret E Walters, MSW

• General Practice Dentistry in San Angelo, TX
• Providers in San Angelo, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; 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.