Gerald Maynard Wall, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4543 Issued in NV

Practice address

1811 S Rainbow Blvd
Suite 101
Las Vegas, NV 89146-0894

Phone

(702) 562-5044

Fax

(702) 562-3289

NPI assigned

Nov 24, 2006

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407921398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 S RAINBOW BLVD",
            "address_2": "SUITE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891460894",
            "telephone_number": "702-562-5044",
            "fax_number": "702-562-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 S RAINBOW BLVD",
            "address_2": "SUITE 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891460894",
            "telephone_number": "702-562-5044",
            "fax_number": "702-562-3289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "GERALD",
        "middle_name": "MAYNARD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yomikalan June'E Walker
• Holly Christine Wall-McCarter, PTA
• Arthur Wall
• Christina Ann Wall, MS OTR/L
• Daniella Louvisa Wall
• Justin Peter Wall, DMD
• Madeline Ann Wall
• Pelle Wall
• Vicki K Wall, M.D.
• Andrew Hyun Wallace

• General Practice Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• 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.

Verify at the official NPI Registry.