Tabitha A Wallace, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

2217 Issued in AR

Practice address

12921 Cantrell Road
Suite 101
Little Rock, AR 72223-1798

Phone

(501) 664-3279

Fax

(501) 664-5392

NPI assigned

Dec 30, 2011

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Donald a Deems III DDS PA

  • General Practice Dentistry
  • Little Rock, AR
  • NPI 1578639167
  NPD (past)
• Rebecca Thompson Siria DMD PLLC

  • Dental Clinic/Center
  • Little Rock, AR
  • NPI 1477302719
  NPD (past)

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325203200000",
    "number": "1629348198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12921 CANTRELL ROAD",
            "address_2": "SUITE 101",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722231798",
            "telephone_number": "501-664-3279",
            "fax_number": "501-664-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12921 CANTRELL ROAD",
            "address_2": "SUITE 101",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722231798",
            "telephone_number": "501-664-3279",
            "fax_number": "501-664-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TABITHA",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-30",
        "last_updated": "2011-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "AR",
            "license": "2217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jimmie Lou Wallace, CRNA
• Jordan Jehree Wallace, PA-C
• Joshua Taylor Wallace, APRN
• Madeline G Wallace, RD
• Meagan Wallace
• Thomas Witherspoon Wallace, MD
• Tiffany Wallace, PLMSW
• Ceon Evonne Waller
• Emily Katherine Waller, MD
• Larry Henle Waller, M.D.

• Dental Hygienist in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Dental Hygienist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; 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.