NPIMap

Organization Active NPI

Big Smile Dental

  • Dental Clinic/Center
  • Fredericksburg, VA
National Provider Identifier
1902329329
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
0401410947 Issued in VA
Legal business name
BIG SMILE DENTAL
Practice address
1315 Jefferson Davis Hwy
Fredericksburg, VA 22401-4640
Phone
(540) 899-1777
Fax
(540) 899-2266
NPI assigned
Jul 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Carter M Waller, DMDNPI 1407098197
Title
Dentist
Phone
(540) 899-1777

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 0401410947 VA Primary
Dental Clinic/Center 261QD0000X 0401415285 VA

Addresses

Primary practice location

1315 Jefferson Davis Hwy
Fredericksburg, VA 22401-4640

Mailing address

1315 Jefferson Davis Hwy
Fredericksburg, VA 22401-4640
Phone (540) 899-1777

National Provider Directory

National Provider Directory
Tax ID family
Big Smile Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the 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": "1500336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1902329329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 JEFFERSON DAVIS HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014640",
            "telephone_number": "540-899-1777",
            "fax_number": "540-899-2266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 JEFFERSON DAVIS HWY",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014640",
            "telephone_number": "540-899-1777",
            "fax_number": "540-899-2266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG SMILE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "CARTER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "540-899-1777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401410947",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "VA",
            "license": "0401415285",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.