NPIMap

Organization Active NPI

Caroline Wallace DDS

  • Dentist
  • Salem, VA
National Provider Identifier
1295819738
Registry record updated Mar 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401007934 Issued in VA
Legal business name
CAROLINE WALLACE DDS
Practice address
103 South Colorado Street
Salem, VA 24153
Phone
(540) 387-3844
Fax
(540) 387-3845
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2014

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

Authorized official

Name
Caroline Wallace, DDSNPI 1134545494
Title
Owner-President
Phone
(340) 387-3844

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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 0401007934 VA Primary

Addresses

Primary practice location

103 South Colorado Street
Salem, VA 24153

Mailing address

103 South Colorado Street
Salem, VA 24153
Phone (540) 387-3844

National Provider Directory

National Provider Directory

Locations

103 S Colorado St
Salem, VA 24153
Phone (540) 387-3844

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394496000000",
    "number": "1295819738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SOUTH COLORADO STREET",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "24153",
            "telephone_number": "540-387-3844",
            "fax_number": "540-387-3845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SOUTH COLORADO STREET",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "24153",
            "telephone_number": "540-387-3844",
            "fax_number": "540-387-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINE WALLACE DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2014-03-11",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "OWNER-PRESIDENT",
        "authorized_official_telephone_number": "340-387-3844",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401007934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; 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.