NPIMap

Organization Active NPI

Wallis Dental LLC

  • Dental Clinic/Center
  • Lexington, MA
National Provider Identifier
1831867985
Registry record updated Sep 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
WALLIS DENTAL LLC
Practice address
1 Wallis CT Ste 4
Lexington, MA 02421-5416
Phone
(781) 862-6565
NPI assigned
Sep 2, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2021

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

Authorized official

Name
Dr. Min Jung Kim, DMDNPI 1659444099
Title
Dr.
Phone
(781) 862-6565

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
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1 Wallis CT Ste 4
Lexington, MA 02421-5416

Mailing address

1 Wallis CT Ste 4
Lexington, MA 02421-5416
Phone (781) 862-6565

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1630540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1831867985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WALLIS CT STE 4",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024215416",
            "telephone_number": "781-862-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WALLIS CT STE 4",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024215416",
            "telephone_number": "781-862-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLIS DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-02",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MIN JUNG",
        "authorized_official_title_or_position": "DR.",
        "authorized_official_telephone_number": "781-862-6565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.