David a. Wallace, DDS, Ms, LTD.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

03440 Issued in VA

Legal business name

DAVID A. WALLACE, DDS, MS, LTD.

Practice address

3712 S Main St
Blacksburg, VA 24060-7017

Phone

(540) 552-7222

Fax

(540) 953-3096

NPI assigned

Sep 11, 2007

Organization subpart

No

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

Authorized official

Name

Ella Hurst

Title

Ofc. MNGR.

Phone

(304) 425-2611

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1356536593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3712 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-552-7222",
            "fax_number": "540-953-3096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3712 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-552-7222",
            "fax_number": "540-953-3096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID A. WALLACE, DDS, MS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2023-09-06",
        "status": "A",
        "authorized_official_last_name": "HURST",
        "authorized_official_first_name": "ELLA",
        "authorized_official_title_or_position": "OFC. MNGR.",
        "authorized_official_telephone_number": "304-425-2611"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "03440",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "1880",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0138333000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8000476",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel B. Drysdale, MD, PC
• Daniel E. Thompson, Dennis C.Schnecker&Damon B. Thompson, PC
• Stephen Daniel, DO
• Anastasia Danilevsky, MD
• Ranadheer Vinayakmurthy Danturthy, MBBS
• David B. Stoeckle, M.D., P.a., P.C.
• David J Hedges MD PC
• Amy Davis, ATC
• Nathaniel Davis, R.N.
• Sarah Davis, LCSW

• Oral and Maxillofacial Surgery (Dentist) in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.