Nina Wallick, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN31036 Issued in FL

Practice address

812 SW Federal Hwy
Stuart, FL 34994-2939

Phone

(772) 287-1671

NPI assigned

Jun 19, 2023

Sex

Female

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

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 and National Provider Directory roles.

• Three Rivers Dental Group/Cranberry LLC

  • Dentist
  • Cranberry TWP, PA
  • NPI 1134659816
  NPD

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1861177834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 W MALLORY BLVD",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334588772",
            "telephone_number": "561-818-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 SW FEDERAL HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942939",
            "telephone_number": "772-287-1671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLICK",
        "first_name": "NINA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-19",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN31036",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS044144",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antwion Nathaniel Wallace
• Cathleen Marie Wallen Beauseigneur, LCSW
• Betty L Wallen, CRNA
• Joshauna Audreyann Wallen
• Samanthia Wash Waller
• Berdashia Moesha Walls
• Laneil Nicola Walls
• Jordan Walrond
• Walter D. Devault III M.D. P.a.
• Hannah Marie Walters

• Dentist in Stuart, FL
• Providers in Stuart, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; 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.