Active NPI
Chase Waller, DMD
- General Practice Dentistry
- Greensboro, NC
National Provider Identifier
1508611146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13860
- Practice address
- 2643 Randleman Rd
Greensboro, NC 27406-5153 - Phone
- (336) 544-2758
- NPI assigned
- Apr 18, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13860 | NC | Primary |
Addresses
Primary practice location
2643 Randleman Rd
Greensboro, NC 27406-5153
Mailing address
2640 S University Dr Apt 217
Davie, FL 33328-1477
Phone (727) 678-9836
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13860 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720656000000",
"number": "1508611146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2640 S UNIVERSITY DR APT 217",
"city": "DAVIE",
"state": "FL",
"postal_code": "333281477",
"telephone_number": "727-678-9836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2643 RANDLEMAN RD",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274065153",
"telephone_number": "336-544-2758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "CHASE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-18",
"last_updated": "2024-07-11",
"certification_date": "2024-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "13860",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.