Jody Paul Wallace, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7500 Issued in NC

Practice address

2148 Highway 54
Graham, NC 27253

Phone

(336) 578-3884

Fax

(336) 578-3814

NPI assigned

Jul 3, 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 7, 2016 through Mar 7, 2028

Medicare enrollment (NPD)

Not 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.

• Jerome M Crayle DDS PLLC

  • General Practice Dentistry
  • Graham, NC
  • NPI 1205927860
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740210103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2148 HIGHWAY 54",
            "city": "GRAHAM",
            "state": "NC",
            "postal_code": "27253",
            "telephone_number": "336-578-3884",
            "fax_number": "336-578-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2148 HIGHWAY 54",
            "city": "GRAHAM",
            "state": "NC",
            "postal_code": "27253",
            "telephone_number": "336-578-3884",
            "fax_number": "336-578-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JODY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "7500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89902J1",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vision of Therapeutic Development, Inc.
• Visions at Hand
• Walgreen Co (Rite Aid)
• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #09090)
• Walton Healthcare Training
• Elizabeth Rose Watson-Ormond, CRNM
• Carol Louise Watson
• Kenneth Paul Way Jr., PHARMD
• Vail Thach Weiglein, OTR/L

• General Practice Dentistry in Graham, NC
• Providers in Graham, NC by specialty
• General Practice Dentistry in North Carolina

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.