Active NPI
Wade Cody Walters, DDS
- General Practice Dentistry
- Dodge City, KS
National Provider Identifier
1396813895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7008
- Practice address
- 2300 N 14TH Street
Suite 202
Dodge City, KS 67801 - Phone
- (620) 225-2650
- Fax
- (620) 225-7722
- NPI assigned
- Dec 1, 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7008 | KS | Primary |
Addresses
Primary practice location
2300 N 14TH Street
Suite 202
Dodge City, KS 67801
Mailing address
2300 N 14TH Street
Suite 202
Dodge City, KS 67801
Phone (620) 225-2650
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 59642 | Other | KS | BC & BS OF KANSAS |
| 1417934 | Other | KS | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2018 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7008 | KS | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dodge City Dental Care | General Practice | 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.
-
- General Practice Dentistry
- Dodge City, KS
- NPI 1477621159
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259712000000",
"number": "1396813895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 N 14TH STREET",
"address_2": "SUITE 202",
"city": "DODGE CITY",
"state": "KS",
"postal_code": "67801",
"telephone_number": "620-225-2650",
"fax_number": "620-225-7722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 N 14TH STREET",
"address_2": "SUITE 202",
"city": "DODGE CITY",
"state": "KS",
"postal_code": "67801",
"telephone_number": "620-225-2650",
"fax_number": "620-225-7722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "WADE",
"middle_name": "CODY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2009-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KS",
"license": "7008",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC & BS OF KANSAS",
"identifier": "59642",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "1417934",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dodge City, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.