Thomas Gregory Van de Walle, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

21761 Issued in TX

Practice address

111 Willow Springs Dr
San Marcos, TX 78666-5240

Phone

(512) 878-2540

Fax

(512) 878-2803

NPI assigned

Oct 10, 2006

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

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 May 31, 2016 through May 31, 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 and National Provider Directory roles.

• Van de Walle Family Dentistry

  • Dental Clinic/Center
  • San Marcos, TX
  • NPI 1649536244
  NPD (past) Authorized official

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1801984448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 WILLOWS SPRINGS DR",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786666076",
            "telephone_number": "512-878-2540",
            "fax_number": "512-878-2803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 WILLOW SPRINGS DR",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786665240",
            "telephone_number": "512-878-2540",
            "fax_number": "512-878-2803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DE WALLE",
        "first_name": "THOMAS",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "21761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Uselding, LAT, ATC
• Alyssa Valdez
• Bethany Valencia, FNP
• Michael Valenzuela, B.S., ATC, LAT
• Van de Walle Family Dentistry
• Robert W Vanboven, MD DDS
• Hector Hugo Vasquez, M.D.
• Brittanie Vaughn, MAT, ATC, LAT
• Abrielle Jaylyn Vela, OTR/L
• Brianda Lucero Verdin

• General Practice Dentistry in San Marcos, TX
• Providers in San Marcos, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; 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.