NPIMap

Organization Active NPI

Daleville Dental, LLC

  • General Practice Dentistry
  • Daleville, AL
National Provider Identifier
1760477251
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4553 Issued in AL
Legal business name
DALEVILLE DENTAL, LLC
Practice address
526 N Daleville Ave
Daleville, AL 36322-2000
Phone
(334) 598-4994
Fax
(334) 598-4342
NPI assigned
Sep 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Jay Michael Walters, D.D.S.NPI 1881782670
Title
Owner
Phone
(334) 598-4994

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4553 AL Primary

Addresses

Primary practice location

526 N Daleville Ave
Daleville, AL 36322-2000

Mailing address

526 N Daleville Ave
Daleville, AL 36322-2000
Phone (334) 598-4994

Other identifiers 2

IdentifierTypeStateIssuer
820510OtherUCCI
51525448OtherALBC/BS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760477251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 N DALEVILLE AVE",
            "city": "DALEVILLE",
            "state": "AL",
            "postal_code": "363222000",
            "telephone_number": "334-598-4994",
            "fax_number": "334-598-4342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 N DALEVILLE AVE",
            "city": "DALEVILLE",
            "state": "AL",
            "postal_code": "363222000",
            "telephone_number": "334-598-4994",
            "fax_number": "334-598-4342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALEVILLE DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALTERS",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "334-598-4994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "4553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCCI",
            "identifier": "820510",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "51525448",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daleville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.