Christopher Ryan Wallis, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

11503 Issued in MT

Practice address

1125 W Kagy Blvd
Suite 201
Bozeman, MT 59715-5881

Phone

(406) 585-1120

Fax

(406) 587-1988

NPI assigned

Aug 15, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jun 11, 2024 through Jun 11, 2028

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.

• Big Sky Oral & Facial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Bozeman, MT
  • NPI 1710523725
  NPD (past) Authorized official

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

{
    "created_epoch": "1218758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469145600000",
    "number": "1497901995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 W KAGY BLVD",
            "address_2": "SUITE 201",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597155881",
            "telephone_number": "406-585-1120",
            "fax_number": "406-587-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 W KAGY BLVD",
            "address_2": "SUITE 201",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597155881",
            "telephone_number": "406-585-1120",
            "fax_number": "406-587-1988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "CHRISTOPHER",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-15",
        "last_updated": "2016-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MT",
            "license": "11503",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30.022811",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen V Wallace, MPT
• Richard M. Wallace, M.D.
• Steven Mark Wallace, L.M.T
• Kimberly Glendoria Wallen, CRNA
• John L Waller, MD
• Patricia Walls, NNP, MSN, RNC
• Walmart Inc.
• Walmart, Inc.
• Kathryn Gretchen Walpole
• Breanne M Walsh, NP-C

• Oral and Maxillofacial Surgery (Dentist) in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; 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.