John David Wallace, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

19862 Issued in TX

Practice address

8315 Walnut Hill LN Ste 120
Dallas, TX 75231-4218

Phone

(214) 363-9946

Fax

(214) 389-1953

NPI assigned

Nov 10, 2005

Last updated

Jun 16, 2023By 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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• John D. Wallace, DDS, MD, PA

  dba Dallas Oral Surgery Associates

  • Oral and Maxillofacial Surgery (Dentist)
  • Dallas, TX
  • NPI 1356535314
  NPD Authorized official
• Woodhill Anesthesia Group PLLC

  • Anesthesiology Physician
  • Dallas, TX
  • NPI 1851908826
  NPD Authorized official
• Mobile Dental Care Pma, LLC

  • Dentist
  • Dallas, TX
  • NPI 1154715753
  NPD (past)
• Surgistar LP

  dba Woodhill Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Dallas, TX
  • NPI 1386877439
  NPD (past)

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1811978349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8315 WALNUT HILL LN STE 120",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314218",
            "telephone_number": "214-363-9946",
            "fax_number": "214-389-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8315 WALNUT HILL LN STE 120",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752314218",
            "telephone_number": "214-363-9946",
            "fax_number": "214-389-1953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "19862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750242-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darcy Wallace
• Daryariel Wallace
• Elizabeth Wallace, PH.D., CCC
• Jahnnae Monique Wallace, LMT
• Jeanne Wallace, D.O.
• Lajuana Wallace
• Lesleigh Lencola Wallace, PHARM.D.
• Lucy Brooks Wallace, M.D.
• Melissa Baker Wallace, M.D.
• Patricia Wallace

• Oral and Maxillofacial Surgery (Dentist) in Dallas, TX
• Providers in Dallas, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.