Dedicated Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DEDICATED DENTAL PLLC

Practice address

11 Hope Rd Ste 201
Stafford, VA 22554-7287

Phone

(540) 899-1777

NPI assigned

May 3, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Carter M Waller, DMDNPI 1407098197

Title

Part Owner Dentist

Phone

(561) 901-4700

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• Dedicated Dental Doing business as
• Dedicated Dental LLC Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carter Milan Waller, D.M.D.

  • General Practice Dentistry
  • Fredericksburg, VA
  • NPI 1407098197
  NPD Authorized official

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

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620000000000",
    "number": "1700469103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 HOPE RD STE 201",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225547287",
            "telephone_number": "540-318-8691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 HOPE RD STE 201",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225547287",
            "telephone_number": "540-899-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEDICATED DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-03",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "CARTER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PART OWNER DENTIST",
        "authorized_official_telephone_number": "561-901-4700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "0401413995",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "0401416501",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dedicated Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dedicated Dental LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jeremiah Emmanuel Deabreu
• Margaret Dean
• Terra Deavers, MPH, RD
• Alyssa May Decowski Turcios
• Sherrie Dedelow
• Dedicated Smiles PLLC
• Aman Deep, M.D
• Tia Burke Delash, L.P.T.A.
• Rebecca Dele Enitan
• Keira Delgado

• Dental Clinic/Center in Stafford, VA
• Providers in Stafford, VA by specialty
• Dental Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; 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.