Robert R Wallace DMD PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

1774 Issued in SC

Legal business name

ROBERT R WALLACE DMD PA

Practice address

40 Creekview CT
Greenville, SC 29615-4800

Phone

(864) 676-0825

Fax

(864) 676-9859

NPI assigned

Jul 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert Raymond Wallace, DMD

Title

President

Phone

(864) 676-0825

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881614253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 CREEKVIEW CT",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154800",
            "telephone_number": "864-676-0825",
            "fax_number": "864-676-9859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 CREEKVIEW CT",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154800",
            "telephone_number": "864-676-0825",
            "fax_number": "864-676-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT R WALLACE DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-676-0825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "1774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Robards
• J. Belinda Robarge, PA
• James Alexander Robbins, MD
• Jessica Blake Robbins, F.N.P
• Kimberly Robelin
• Ansley Dale Roberts, MS
• Brittany Roberts
• Catherine Hicks Roberts, LISW
• Gabriel Isaac Roberts, PA-C
• Jason Ryan Roberts, M.ED.

• Dental Clinic/Center in Greenville, SC
• Providers in Greenville, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.