Jeffrey H Wallen, DDS

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

2959 Issued in SC

Practice address

1200 48TH Ave N
Suite 101
Myrtle Beach, SC 29577-5425

Phone

(843) 449-4993

Fax

(843) 497-0647

NPI assigned

Feb 15, 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2020 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Jeffrey H Wallen D.D.S. P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Myrtle Beach, SC
  • NPI 1134242621
  NPD (past) Authorized official

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1497729396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 48TH AVE N",
            "address_2": "SUITE 101",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775425",
            "telephone_number": "843-449-4993",
            "fax_number": "843-497-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 48TH AVE N",
            "address_2": "SUITE 101",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775425",
            "telephone_number": "843-449-4993",
            "fax_number": "843-497-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLEN",
        "first_name": "JEFFREY",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "SC",
            "license": "2959",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9905",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8998844",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Irina Walker
• Jade Madison Walker, O.D.
• Katina Walker, LMFT
• Rebecca L Walker, PTA
• William Ashton Wall, MD
• Charles T Walls Jr., MD
• Walmart
• Walser Inc. D/B/a Avada Hearing Center
• Jenna Walter, PT, DPT
• Lauren Walter, CCC-SLP

• Oral & Maxillofacial Surgery (D.M.D.) in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.