Douglas W. Wallace, D.D.S., M.S.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

30-01-6806 Issued in OH

Practice address

5188 Winton Rd
Fairfield, OH 45014-2900

Phone

(513) 829-8080

Fax

(513) 858-4290

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207008000000",
    "number": "1376698753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5188 WINTON RD",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450142900",
            "telephone_number": "513-829-8080",
            "fax_number": "513-858-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5188 WINTON RD",
            "city": "FAIRFIELD",
            "state": "OH",
            "postal_code": "450142900",
            "telephone_number": "513-829-8080",
            "fax_number": "513-858-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DOUGLAS",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2008-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "OH",
            "license": "30-01-6806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Wanjiru Wagura, MD
• Walgreen Co
• Walgreen Co
• Doris G Walker
• Tiffany Lafay Walker, OTA/L
• Monica Lynn Walters, LPN
• Barry J Wanninger, PA-C
• Valerie Lynn Ward
• Jeremy Warden, D.C.
• Claronda Wash-McGoogin

• Oral & Maxillofacial Surgery (D.M.D.) in Fairfield, OH
• Providers in Fairfield, OH by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.