James Philip Wall Sr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14445 Issued in MA

Practice address

754 Country Way
Scituate, MA 02066-1825

Phone

(781) 545-4181

Fax

(781) 545-3928

NPI assigned

Sep 7, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Idg Scituate Dental PC

  • Dental Clinic/Center
  • Scituate, MA
  • NPI 1558023077
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1699878264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 COUNTRY WAY",
            "city": "SCITUATE",
            "state": "MA",
            "postal_code": "020661825",
            "telephone_number": "781-545-4181",
            "fax_number": "781-545-3928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 COUNTRY WAY",
            "city": "SCITUATE",
            "state": "MA",
            "postal_code": "020661825",
            "telephone_number": "781-545-4181",
            "fax_number": "781-545-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "JAMES",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "14445",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "0014445",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "X08245WA",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer K Wilczenski, LIC. AC.

• General Practice Dentistry in Scituate, MA
• Providers in Scituate, MA by specialty
• General Practice Dentistry in Massachusetts

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.