Charity J.E. Vanderwall-Lacey, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

10800 Issued in NC

Practice address

123 Cobia CT
Jacksonville, NC 28546-6862

Phone

(910) 347-1211

NPI assigned

Jun 16, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Charity Vander Wall Former name

Medicare fee-for-service enrollment

Enrolled in DC

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

State licenses

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 and National Provider Directory roles.

• Jon Douglas Lesan DDS RPH PA

  • General Practice Dentistry
  • Jacksonville, NC
  • NPI 1952479156
  NPD
• Carol a Blake, DDS, PLLC

  • Dentist
  • Washington, DC
  • NPI 1679914782
  NPD (past)

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679923080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 COBIA CT",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466862",
            "telephone_number": "910-347-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 COBIA CT",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285466862",
            "telephone_number": "910-347-1211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5225 Wisconsin Ave NW",
            "address_2": "Suite 511",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200152014",
            "country_code": "US",
            "telephone_number": "202-966-0620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANDERWALL-LACEY",
        "first_name": "CHARITY",
        "middle_name": "J.E.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-16",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "DC",
            "license": "DEN1001627",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "10800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARITY",
            "last_name": "VANDER WALL",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Karen Esbeidy Valentine, MSW
• Melissa Vallario
• Paula Valles, LCSWA
• Xiomara Antonetti Vance, MD
• Brianna Lee Vanderpool, PMHNP-BC
• Tess Marie Vanderwerf, DPT
• Richard John Vanek Sr., DDS MSCO
• Jenna Jovet Vannoy
• Brittany Mears Vanpelt, PHARMD
• Madison Vargas

• Dentist in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.