Northrise Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

NORTHRISE DENTAL LLC

Practice address

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

Phone

(575) 521-9375

Fax

(575) 521-2637

NPI assigned

Jan 10, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Jared Wallis, DDSNPI 1396033494

Title

Dentist/Owner

Phone

(575) 521-9375

Specialties & licenses 1

Addresses

Other names 1

• Jared Wallis DDS Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jared S. Wallis, DDS

  • Dentist
  • Las Cruces, NM
  • NPI 1396033494

  General Practice

  NPD Authorized official

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

{
    "created_epoch": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547078400000",
    "number": "1437622503",
    "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": {
        "organization_name": "NORTHRISE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-10",
        "last_updated": "2019-01-10",
        "status": "A",
        "authorized_official_last_name": "WALLIS",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "575-521-9375",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jared Wallis DDS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allison Norris, SLP
• Christine Norris
• Davena Marie Norris, PHARMD, RPH, PHC
• North Main Family Health Center, PC
• Northrise Assisted Living LLC
• Northrise Wellness & Rehabilitation LLC
• Northrise Wellness & Rehabilitation LLC
• Rebecca Northrup
• Northwest Hospital Medicine Physicians LLC
• Michael Drake Norton, PT

• All providers in Las Cruces, NM
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2019; 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.