Active NPI
Ashley Wallace, DMD
- General Practice Dentistry
- Groton, CT
National Provider Identifier
1417466236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN1857727
- Practice address
- 1 Wahoo Ave
Groton, CT 06349-2324 - Phone
- (860) 694-3738
- NPI assigned
- Sep 25, 2017
- Last updated
- Sep 25, 2017
- Sex
- Female
- 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 | DN1857727 | MA | Primary |
Addresses
Primary practice location
1 Wahoo Ave
Groton, CT 06349-2324
Mailing address
1 Wahoo Ave
Groton, CT 06349-2324
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 |
|---|---|---|---|
| DN1857727 | MA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506297600000",
"number": "1417466236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 WAHOO AVE",
"city": "GROTON",
"state": "CT",
"postal_code": "063492324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WAHOO AVE",
"city": "GROTON",
"state": "CT",
"postal_code": "063492324",
"telephone_number": "860-694-3738"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ASHLEY",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-25",
"last_updated": "2017-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MA",
"license": "DN1857727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Groton, CT
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2200)
- Wal-Mart Stores East, LP (Vision Center 30-2200)
- Kathryn Walck, FNP
- Walgreen Co (Electric Boat Family Pharmacy #16491)
- Walgreen Co. (Walgreens #07759)
- John Hugh G Wallace Jr., PHD
- Brian Walton, O.D.
- Watch Point Wellness Center, LLC
- Nicholas Gregory Watters, SUB IDC
- Laura Anne Watts, M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.