Nicholas Patrick Wall, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12321 Issued in MN

Practice address

3655 W Anthem Way
Suite a-117
Anthem, AZ 85086

Phone

(623) 551-5555

Fax

(623) 551-1620

NPI assigned

Mar 9, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Dec 8, 2016 through Dec 8, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: nwall18643@direct.midwestern.edu

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.

• BN3 Dental PLLC

  • Dentist
  • Anthem, AZ
  • NPI 1356687776
  NPD (past)
• Midwestern University

  • Dental Clinic/Center
  • Glendale, AZ
  • NPI 1164744009
  NPD (past)
• Tap Dental PLLC

  • Dentist
  • Anthem, AZ
  • NPI 1043579360
  NPD (past)

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219104000000",
    "number": "1225169154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3655 W ANTHEM WAY",
            "address_2": "SUITE A-117",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "85086",
            "telephone_number": "623-551-5555",
            "fax_number": "623-551-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3655 W ANTHEM WAY",
            "address_2": "SUITE A-117",
            "city": "ANTHEM",
            "state": "AZ",
            "postal_code": "85086",
            "telephone_number": "623-551-5555",
            "fax_number": "623-551-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "NICHOLAS",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-09",
        "last_updated": "2008-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Vogini, LSCW
• Gregory Anthony Wadleigh, D.D.S., M.S.
• Wal-Mart Stores, Inc.
• Angela Walen, FP
• Walgreen Co
• Walmart Inc.
• Deborah Lynn Wang, R.N.
• Alison Ward, PSY.D.
• Andrew C Wen, L.AC.
• Western Med Group LLC

• General Practice Dentistry in Anthem, AZ
• Providers in Anthem, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.