Active NPI
Luke Walz, DDS
- General Practice Dentistry
- Defiance, OH
National Provider Identifier
1508981911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 21831
- Practice address
- 1400 E 2ND St
Defiance, OH 43512-2440 - Phone
- (419) 782-7950
- Fax
- (419) 782-8880
- NPI assigned
- Mar 21, 2007
- Last updated
- Jul 8, 2007
- 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 | 21831 | OH | Primary |
Addresses
Primary practice location
1400 E 2ND St
Defiance, OH 43512-2440
Mailing address
245 Stadium Dr
Defiance, OH 43512-0218
Phone (419) 782-7950
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2703908 | Medicaid | OH | |
| 21831 | Other | OH | LICSNSE NUMBER |
| 1615835 | Other | OH | UNITED CONCORDIA |
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 |
|---|---|---|---|
| 21831 | OH | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Krouse-Evans, Inc. | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508981911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "245 STADIUM DR",
"city": "DEFIANCE",
"state": "OH",
"postal_code": "435120218",
"telephone_number": "419-782-7950",
"fax_number": "419-782-8880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 E 2ND ST",
"city": "DEFIANCE",
"state": "OH",
"postal_code": "435122440",
"telephone_number": "419-782-7950",
"fax_number": "419-782-8880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALZ",
"first_name": "LUKE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "21831",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2703908",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICSNSE NUMBER",
"identifier": "21831",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "1615835",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Defiance, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.