NPIMap

Organization Active NPI

Charles C Wall DDS

  • General Practice Dentistry
  • Salt Lake City, UT
National Provider Identifier
1306060306
Registry record updated Jul 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
51343669922 Issued in UT
Legal business name
CHARLES C WALL DDS
Practice address
2200 East 4500 South
Suite 240
Salt Lake City, UT 84117
Phone
(801) 278-3864
Fax
(801) 278-3868
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2008

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

Authorized official

Name
Dr. Charles C Wall, DDSNPI 1376985655
Title
Owner
Phone
(801) 278-3864

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 DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 51343669922 UT Primary

Addresses

Primary practice location

2200 East 4500 South
Suite 240
Salt Lake City, UT 84117

Mailing address

2200 East 4500 South
Suite 240
Salt Lake City, UT 84117
Phone (801) 278-3864

Other names 1

  • Wall Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

2200 E 4500 S
Ste 240
Salt Lake City, UT 84117
Phone (801) 278-3864

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": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1306060306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 EAST 4500 SOUTH",
            "address_2": "SUITE 240",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84117",
            "telephone_number": "801-278-3864",
            "fax_number": "801-278-3868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 EAST 4500 SOUTH",
            "address_2": "SUITE 240",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "84117",
            "telephone_number": "801-278-3864",
            "fax_number": "801-278-3868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES C WALL DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-278-3864",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "51343669922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wall Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.