Active NPI
William E Wallace, D.M.D.
- Dentist
- Richmond Hill, GA
National Provider Identifier
1710231451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9665
- Practice address
- 10015 Ford Ave
Richmond Hill, GA 31324 - Phone
- (912) 756-3880
- Fax
- (912) 756-3516
- NPI assigned
- Nov 2, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9665 | GA | Primary |
Addresses
Primary practice location
10015 Ford Ave
Richmond Hill, GA 31324
Mailing address
PO Box 760
Richmond Hill, GA 31324-0760
Phone (912) 756-3880
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9665 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351814400000",
"number": "1710231451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 760",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313240760",
"telephone_number": "912-756-3880",
"fax_number": "912-756-3516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10015 FORD AVE",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "31324",
"telephone_number": "912-756-3880",
"fax_number": "912-756-3516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "WILLIAM",
"middle_name": "E",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-11-02",
"last_updated": "2012-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "9665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond Hill, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.