Douglas R Wall, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

31417 Issued in CA

Practice address

5479 E Abbeyfield St
#4
Long Beach, CA 90815-3050

Phone

(562) 597-1414

Fax

(562) 498-6174

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

No

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

Enrolled in CA

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

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214784000000",
    "number": "1467462002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5479 E ABBEYFIELD ST",
            "address_2": "# 4",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153050",
            "telephone_number": "562-597-1414",
            "fax_number": "562-498-6174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5479 E ABBEYFIELD ST",
            "address_2": "#4",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153050",
            "telephone_number": "562-597-1414",
            "fax_number": "562-498-6174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "DOUGLAS",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2008-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "31417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sidney Walker
• Stephanie Marie Walker, MD
• Terri Walker
• Tiffany Renee' Walker
• Debbie Ann Wall, A.A., B.A.
• Wendie Wall, MS CCC-SLP
• Zackary John Wall, RAC (INTERN)
• Ashari Wallace, MSW
• Bruce Sterling Wallace II, PSYD
• Melany A Wallace

• Dentist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.