Jared S. Wallis, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3512 Issued in NM

Practice address

2540 N Telshor Blvd Ste E
Las Cruces, NM 88011-8201

Phone

(575) 521-9375

Fax

(575) 521-2637

NPI assigned

Jul 11, 2011

Last updated

Feb 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northrise Dental LLC

  dba Jared Wallis DDS

  • General Practice Dentistry
  • Las Cruces, NM
  • NPI 1437622503
  NPD Authorized official

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

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1396033494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2540 N TELSHOR BLVD STE E",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118201",
            "telephone_number": "575-521-9375",
            "fax_number": "575-521-2637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 N TELSHOR BLVD STE E",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118201",
            "telephone_number": "575-521-9375",
            "fax_number": "575-521-2637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "JARED",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-11",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "3512",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "3512",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Jon Wallace, CPSW
• Makayla Wallender
• Michelle Waller, RBT
• Wendi Cheree Wallin, DC
• Wallis Enterprises Inc (Las Cruces Rexall)
• Leah Wallis
• Georgine Walsh, CF-SLP
• Stephanie Walterman
• Marcos Antonio Walters, RN
• Maria Leslie Wandemberg

• Dentist in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.