NPIMap

Organization Active NPI

Matthew D Wall DDS MSD PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Lacey, WA
National Provider Identifier
1962888636
Registry record updated Aug 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
60048046 Issued in WA
Legal business name
MATTHEW D WALL DDS MSD PLLC
Practice address
5320 Corporate Center Loop SE Ste a
Lacey, WA 98503-5557
Phone
(360) 491-7080
Fax
(360) 491-7105
NPI assigned
Aug 5, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2015

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

Authorized official

Name
Matthew D Wall, DDS MSDNPI 1114253846
Title
Owner
Phone
(360) 491-7080

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
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 60048046 WA Primary

Addresses

Primary practice location

5320 Corporate Center Loop SE Ste a
Lacey, WA 98503-5557

Mailing address

5320 Corporate Center Loop SE Ste a
Lacey, WA 98503-5557
Phone (360) 491-7080

National Provider Directory

National Provider Directory

Locations

5320 Corporate Center Loop SE
Ste A
Lacey, WA 98503
Phone (360) 491-7080

Practitioners & affiliated clinicians

Practitioners 2

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": "1438732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438732800000",
    "number": "1962888636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 CORPORATE CENTER LOOP SE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035557",
            "telephone_number": "360-491-7080",
            "fax_number": "360-491-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 CORPORATE CENTER LOOP SE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035557",
            "telephone_number": "360-491-7080",
            "fax_number": "360-491-7105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW D WALL DDS MSD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-05",
        "last_updated": "2015-08-05",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-491-7080",
        "authorized_official_credential": "DDS MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "60048046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; 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.