Jay M Walters Sr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4553 Issued in AL

Practice address

526 N Daleville Ave
Daleville, AL 36322-2000

Phone

(334) 598-4994

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Daleville Dental, LLC

  • General Practice Dentistry
  • Daleville, AL
  • NPI 1760477251
  NPD (past) Authorized official
• Daleville Dental II, LLC

  • General Practice Dentistry
  • Daleville, AL
  • NPI 1396471843
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881782670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 N DALEVILLE AVE",
            "city": "DALEVILLE",
            "state": "AL",
            "postal_code": "363222000",
            "telephone_number": "334-598-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 N DALEVILLE AVE",
            "city": "DALEVILLE",
            "state": "AL",
            "postal_code": "363222000",
            "telephone_number": "334-598-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "JAY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "4553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "380241",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCCI",
            "identifier": "820510",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "515-25448",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunland Optical Co., Inc.
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• Audyanna R Vialpando
• Travera Elizabeth Walker, REGISTERED NURSE
• Alannah Larimore Walters
• Eden B Waters
• Shelley C Wiggins, PHARMD
• Ericka Williams
• Michael A. Williams, D.O.
• Darlene Wise, OPTICIAN

• General Practice Dentistry in Daleville, AL
• Providers in Daleville, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.