Glynis Dynel Wallace, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

37179 Issued in CA

Practice address

779 W 20TH St Apt 7
San Pedro, CA 90731-5359

Phone

(562) 221-1852

NPI assigned

Feb 24, 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

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

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298505600000",
    "number": "1669779732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "779 W 20TH ST APT 7",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907315359",
            "telephone_number": "562-221-1852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "779 W 20TH ST APT 7",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907315359",
            "telephone_number": "562-221-1852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "GLYNIS",
        "middle_name": "DYNEL",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-24",
        "last_updated": "2011-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "37179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aleksandar Vukotic, D.D.S.
• Ravina Wadhwani
• Genesa Wagoner, M.D.
• Elizabeth Messiha Wahba
• Nicole D Walker
• Chuanxin Wang
• Robin Mia Ward
• Vaughndrell Lance Watkins, RADT
• Charlotte Lynn Watters
• Herbert Haldeman Webb, MD

• General Practice Dentistry in San Pedro, CA
• Providers in San Pedro, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.