Active NPI
John Dean Wallace Jr., DDS
- General Practice Dentistry
- Santee, CA
National Provider Identifier
1629241070
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22186
- Practice address
- 9913 Mission Gorge Rd Unit 1
Santee, CA 92071-3843 - Phone
- (619) 448-3214
- NPI assigned
- Apr 8, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 22186 | CA | Primary |
Addresses
Primary practice location
9913 Mission Gorge Rd Unit 1
Santee, CA 92071-3843
Mailing address
9913 Mission Gorge Rd Unit 1
Santee, CA 92071-3843
Phone (619) 448-3214
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 |
|---|---|---|---|
| 22186 | CA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1629241070",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9913 MISSION GORGE RD UNIT 1",
"city": "SANTEE",
"state": "CA",
"postal_code": "920713843",
"telephone_number": "619-448-3214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9913 MISSION GORGE RD UNIT 1",
"city": "SANTEE",
"state": "CA",
"postal_code": "920713843",
"telephone_number": "619-448-3214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "JOHN",
"middle_name": "DEAN",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-08",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "22186",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santee, CA
- Vraj Pharmacy LLC (All Care Pharmacy - LTC)
- Jocelyn Vu
- Trang Quynh Vu
- Walgreen Co. (Walgreens #09817)
- Riley Marie Walker, APRN
- Natasha Dawn Wallgren
- Walmart Inc. (Walmart Pharmacy 10-1917)
- Walmart Stores, Inc. (Vision Center 30-1917)
- Madeline Leah Warner, DDS
- Way Cool Homecare, Inc (Comfort Keepers)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.