Bradley Wallace, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14228509-9926 Issued in UT

Practice address

853 E 9400 S
Sandy, UT 84094-3655

Phone

(801) 572-5550

NPI assigned

Jul 16, 2025

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

Practice roles

Locations

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.

• Elevate Dental Partners

  • General Practice Dentistry
  • Sandy, UT
  • NPI 1750151718
  NPD
• Elevate Dental Partners

  • General Practice Dentistry
  • Bountiful, UT
  • NPI 1982472536
  NPD (past)

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

{
    "created_epoch": "1752624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1487546305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5327 W CANARY GRASS WAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840091399",
            "telephone_number": "801-662-8371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 E 9400 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840943655",
            "telephone_number": "801-572-5550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6065 S Fashion Blvd Ste 275",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "UT",
            "postal_code": "841075441",
            "country_code": "US",
            "telephone_number": "462-880-1262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BRADLEY",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-16",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "14228509-9926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn E Walker, MD
• Lisa Ann Walker, LCSW
• Michael T. Walker, AU.D.
• Wall Medical Inc
• Michael J Wall, MD
• Renee Wallace, CSW
• Walmart Inc.
• Carol Wang
• Timothy Andrew Wann, DC
• Nicholas Warlin, PHARMD

• General Practice Dentistry in Sandy, UT
• Providers in Sandy, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.