Dustin Guy Wallace, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4095 Issued in AR

Practice address

2801 S Olive St
Pine Bluff, AR 71603-5433

Phone

(870) 663-4180

NPI assigned

Jun 9, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521504000000",
    "number": "1770932808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 ARROWHEAD RD",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716039443",
            "telephone_number": "870-543-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S OLIVE ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716035433",
            "telephone_number": "870-663-4180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DUSTIN",
        "middle_name": "GUY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-09",
        "last_updated": "2018-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "32331",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "4095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walker Healthcare for Women
• Joyce Walker, LCSW
• Paula Denise Walker, LPN
• Nita M Wall, LMSW
• Shelby Wall, PHARMD
• Rosalind Wallace, PLMSW
• Walmart Inc.
• Susan Hoggard Wamble, D.D.S. M.S.
• Mya Ware
• Regina Warner

• General Practice Dentistry in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.