NPIMap

Organization Active NPI

Robert E Wall DDS, PC

  • General Practice Dentistry
  • Madison, IN
National Provider Identifier
1255402665
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007187 Issued in IN
Legal business name
ROBERT E WALL DDS, PC
Practice address
753 W Main St
Madison, IN 47250-3150
Phone
(812) 265-5962
Fax
(812) 273-1085
NPI assigned
Nov 10, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert E Wall, DDSNPI 1972674372
Title
Owner
Phone
(812) 265-5962

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12007187 IN Primary

Addresses

Primary practice location

753 W Main St
Madison, IN 47250-3150

Mailing address

753 W Main St
Madison, IN 47250-3150
Phone (812) 265-5962

National Provider Directory

National Provider Directory

Locations

753 W Main St
Madison, IN 47250
Phone (812) 265-5962

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255402665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "753 W MAIN ST",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472503150",
            "telephone_number": "812-265-5962",
            "fax_number": "812-273-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "753 W MAIN ST",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472503150",
            "telephone_number": "812-265-5962",
            "fax_number": "812-273-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT E WALL DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-265-5962",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.