R Jeffrey Wallace DDS PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

R JEFFREY WALLACE DDS PLLC

Practice address

111 Peacock Court
Seymour, TN 37865

Phone

(865) 577-0194

Fax

(865) 577-0174

NPI assigned

Feb 14, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. R Jeffrey Wallace, DDS

Title

Owner President

Phone

(865) 577-0194

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1538201454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 PEACOCK COURT",
            "city": "SEYMOUR",
            "state": "TN",
            "postal_code": "37865",
            "telephone_number": "865-577-0194",
            "fax_number": "865-577-0174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PEACOCK COURT",
            "city": "SEYMOUR",
            "state": "TN",
            "postal_code": "37865",
            "telephone_number": "865-577-0194",
            "fax_number": "865-577-0174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R JEFFREY WALLACE DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "865-577-0194",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Joy Poole, MA
• Wilson Lee Powers, MD
• Traci Marie Prater, LPN
• Pro Therapy Services of East Tennessee
• Sara Loudermilk Propst, PH.D.
• Catherine Rains, APRN
• Abigail Grace Ratliff, PHARMD
• Mark Reddington, D.O.
• Sabrina Leanne Ridge
• Jerica Kristin Nicole Robertson, DO

• General Practice Dentistry in Seymour, TN
• Providers in Seymour, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.