JEFFREY H WALLEN D.D.S. P.C. (NPI# 1134242621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134242621 |
| Entity Type | Organization |
| Organization Name | JEFFREY H WALLEN D.D.S. P.C. |
| Practice Address |
1200 48th Ave N Ste 101 Myrtle Beach SC 29577-5423 |
| Practice Telephone | 8434494993 |
| Practice Fax Number | 8434970647 |
| Mailing Telephone | 8434494993 |
| Mailing Fax Number | 8434970647 |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2008-06-05 |
| Authorized Official Name | DR. JEFFREY HUGH WALLEN (OWNER) |
| Authorized Official Telephone | 8434494993 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
2959 | SC | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | NORTH CAROLINA MEDICIAD | 8998844 | 01 |
| SC | ZA9905 | 05 |
| Street Address |
1200 48TH AVE N STE 101 |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29577-5423 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124536446 | Well Care Home Health of The Lowcountry | Home Health | 1039 44th Ave N Ste 101, Myrtle Beach, SC 29577 | 2018-01-22 |
| 1518470913 | Guillot Enterprises, LLC | Hearing Instrument Specialist | 1294 Professional Dr., Suite C, Myrtle, SC 29577 | 2017-11-08 |
| 1598288227 | Ryan Shepherd | Pharmacist | 1705 South Kings Highway, Myrtle Beach, SC 29577 | 2017-07-25 |
| 1184176554 | Shannon Long | Counselor | 1293 Professional Drive, Suite D Office 222, Myrtle Beach, SC 29577 | 2016-11-01 |
| 1265898191 | Coastal Carolina Infectious Disease, LLC | Internal Medicine | 1110 London St Ste 102, Myrtle Beach, SC 29577 | 2016-01-07 |
| 1548639933 | Susan Lang | Social Worker | 1273 Professional Dr., Suite A #104, Myrtle Beach, SC 29577 | 2015-09-16 |
| 1043600893 | Kenneth Edward Smith | Counselor | 1125 48th Avenue North, Myrtle Beach, SC 29577 | 2015-02-02 |
| 1902203615 | Sc Nursing Services LLC | Home Infusion | 1297 Professional Drive, Suite 201 C3, Myrtle Beach, SC 29577 | 2014-11-24 |
| 1881007946 | Intercoastal Endo, PC | Dentist | 4382 Oleander Dr, Myrtle Beach, SC 29577 | 2014-06-06 |
| 1891115739 | Julie Hite | Pharmacist | 540 Seaboard Street, Myrtle Beach, SC 29577 | 2014-04-18 |
| Find all providers in zip 29577 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922195924 | Charles Elliott Maxwell | Dentist | 133 Tourne Centre Parkway, Myrtle Beach, SC 29579 | 2006-10-10 |
| 1194812339 | Coastal Carolina Oral Maxillofacial Surgery | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579 | 2006-10-09 |
| 1427324243 | Michael Allan Johnson | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579-3493 | 2012-03-27 |
| 1770672503 | Brian C Harsha | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579 | 2006-10-12 |
| 1245329051 | Edward F. Eckert Jr. | Dentist | 133 Towne Centre Pkwy, Myrtle Beach, SC 29579 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356963508 | Clements Ferry Dentistry LLC | Dentist | 1951 Clements Ferry Rd Ste 201, Charleston, SC 29492-8325 | 2020-05-11 |
| 1851945497 | Kacy Wonder | Dentist | 173 Ashley Avenue Room 453 Msc 507, Charleston, SC 29425 | 2019-08-01 |
| 1164990164 | Camden Oral Surgery & Implant Center | Dentist | 207 E. Dekalb St., Camden, SC 29020 | 2018-11-07 |
| 1417309956 | Marian Mitchell Oliver Corp. | Dentist | 939 Jc Calhoun Drive, Orangeburg, SC 29115 | 2016-07-08 |
| 1205290764 | Sloan Rehder | Dentist | 2051 Sam Rittenberg Blvd, Charleston, SC 29407-4683 | 2016-04-11 |
| 1689039869 | Faircloth and Bakeman Partnership | Dentist | 150 Crepe Myrtle Dr, Aiken, SC 29803-7543 | 2015-12-15 |
| 1679954705 | Coafs Lab | Dentist | 125 Wappoo Creek Dr Ste C1, Charleston, SC 29412-2161 | 2015-06-15 |
| 1952798357 | Now Or Never 2011, LLC | Dentist | 2270 Ashley Crossing Dr Ste 175, Charleston, SC 29414-5863 | 2015-04-23 |
| 1922499011 | Chapin Oral and Maxillofacial Surgery, LLC | Dentist | 112 St. Peter's Church Road, Chapin, SC 29036 | 2015-02-10 |
| 1437557121 | Sumter Oral & Maxillofacial Surgery | Dentist | 624 Front St, Georgetown, SC 29440-3624 | 2014-12-11 |
| Find all providers with the same taxonomy | ||||
| City | MYRTLE BEACH |
| Zip Code | 29577 |
Please comment or provide details below to improve the information on JEFFREY H WALLEN D.D.S. P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.