Brad J Wall, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MT1999 Issued in MT

Practice address

1001 SW Higgins
Suite 107
Missoula, MT 59803

Phone

(406) 728-6068

Fax

(406) 829-0868

NPI assigned

Sep 14, 2006

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

Other identifiers 1

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 Sep 22, 2015 through Sep 22, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: bwall18584@direct.midwestern.edu

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.

• Midwestern University

  dba Midwestern University Dental Institute

  • Dental Clinic/Center
  • Glendale, AZ
  • NPI 1164744009
  NPD (past)

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619072444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 SW HIGGINS",
            "address_2": "SUITE 107",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59803",
            "telephone_number": "406-728-6068",
            "fax_number": "406-829-0868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SW HIGGINS",
            "address_2": "SUITE 107",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59803",
            "telephone_number": "406-728-6068",
            "fax_number": "406-829-0868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "BRAD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "MT1999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0112242",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Walker, D.C
• Joscelyn L Walker, PHARMD
• Kathleen Walker
• Katrina Walker, RDH
• Samuel Dean Walker, ATC, LAT
• John Isackson Wallace
• Jolene C Wallace, COMS
• Sam A Wallace, D.O.
• Walman Optical Company
• Walmart Inc. (Walmart Pharmacy 10-3259)

• General Practice Dentistry in Missoula, MT
• Providers in Missoula, MT by specialty
• General Practice Dentistry in Montana

• 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.
• 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.