Wallace C. Carrillo-Medina, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9900 Issued in NC

Practice address

101 Northpoint Ave
High Point, NC 27262-7719

Phone

(336) 883-6450

Fax

(336) 883-6451

NPI assigned

Aug 2, 2011

Last updated

Apr 14, 2026By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NC

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Wallace Carrillo-Medina DMD Ms PA

  • Orofacial Pain Dentistry
  • Asheboro, NC
  • NPI 1689290173
  NPD Authorized official
• Lane and Associates Xxxviii DDS PA

  • Dentist
  • High Point, NC
  • NPI 1821623620

  General Practice

  NPD
• Annie M Reid D.D.S.

  • General Practice Dentistry
  • High Point, NC
  • NPI 1801086467
  NPD (past)

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776124800000",
    "number": "1558649947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NORTHPOINT AVE",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627719",
            "telephone_number": "336-883-6450",
            "fax_number": "336-883-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NORTHPOINT AVE",
            "city": "HIGH POINT",
            "state": "NC",
            "postal_code": "272627719",
            "telephone_number": "336-883-6450",
            "fax_number": "336-883-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO-MEDINA",
        "first_name": "WALLACE",
        "middle_name": "C.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-02",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "9900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carolina Progressive Therapy Services P.C.
• Carolina Regional Heart Center
• Carolina Surgical Center
• Carolina Womancare P.a.
• Katherine Carrier, LPC
• Tony Carroll, PA
• Avis Carter, RN, BSN
• John Christopher Carter, MD
• Sarah Cincinnati Carter, FNP-BC
• Carters Care, LLC

• General Practice Dentistry in High Point, NC
• Providers in High Point, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.