Individual provider Active NPI

Walter J Wulf, DDS PA

  • General Practice Dentistry
  • Wilmington, NC
National Provider Identifier
1831293935
Registry record updated Jan 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6107 Issued in NC
Practice address
2253 Carolina BCH Rd
Wilmington, NC 28401
Phone
(910) 343-0830
Fax
(910) 343-8559
NPI assigned
Sep 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6107 NC Primary

Addresses

Primary practice location

2253 Carolina BCH Rd
Wilmington, NC 28401

Mailing address

2253 Carolina BCH Rd
Affordable Dentures
Wilmington, NC 28401

Other identifiers 1

IdentifierTypeStateIssuer
5901753MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160218001170 NC Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6002120946

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Walter J. Wulf, DDS, P.a. Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327536000000",
    "number": "1831293935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2253 CAROLINA BCH RD",
            "address_2": "AFFORDABLE DENTURES",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28401",
            "fax_number": "910-343-8559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2253 CAROLINA BCH RD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28401",
            "telephone_number": "910-343-0830",
            "fax_number": "910-343-8559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WULF",
        "first_name": "WALTER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DDS PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2012-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "6107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901753",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.