Active NPI
Eric Boles Wall, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Stockton, CA
National Provider Identifier
1366479230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 26796
- Practice address
- 6529 Inglewood Ave
A-1
Stockton, CA 95207-3864 - Phone
- (209) 473-3788
- Fax
- (209) 473-2775
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 26796 | CA | Primary |
Addresses
Primary practice location
6529 Inglewood Ave
A-1
Stockton, CA 95207-3864
Mailing address
6529 Inglewood Ave
A-1
Stockton, CA 95207-3864
Phone (209) 473-3788
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26796 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| M Elder D D S a Professional Corporation | Oral and Maxillofacial Surgery | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Oral and Maxillofacial Surgery (Dentist)
- Pinole, CA
- NPI 1760633341
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1366479230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6529 INGLEWOOD AVE",
"address_2": "A-1",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952073864",
"telephone_number": "209-473-3788",
"fax_number": "209-473-2775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6529 INGLEWOOD AVE",
"address_2": "A-1",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952073864",
"telephone_number": "209-473-3788",
"fax_number": "209-473-2775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "ERIC",
"middle_name": "BOLES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "26796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.