DAVID A. WALLACE, DDS, MS, LTD. (NPI# 1356536593) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356536593 |
| Entity Type | Organization |
| Organization Name | DAVID A. WALLACE, DDS, MS, LTD. |
| Practice Address |
3712 S Main St Blacksburg VA 24060-7017 |
| Practice Telephone | 5405527222 |
| Practice Fax Number | 5409533096 |
| Mailing Telephone | 5405527222 |
| Mailing Fax Number | 5409533096 |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2007-09-11 |
| Authorized Official Name | ELLA HURST (OFC. MNGR.) |
| Authorized Official Telephone | 3044252611 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
1880 | WV | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
03440 | VA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 8000476 | 05 | |
| WV | 0138333000 | 05 |
| Street Address |
3712 S MAIN ST |
| City | BLACKSBURG |
| State | VA |
| Zip Code | 24060-7017 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144789215 | Center for Cognition, Language & Speech, LLC | Speech-Language Pathologist | 1999 South Main St., Suite 303, Blacksburg, VA 24060 | 2019-03-18 |
| 1669945465 | Hannah Jacqueline Lower | Physical Therapy Assistant | Kroontje Healthcare Center, 100 Litton Lane, Blacksburg, VA 24060 | 2019-01-04 |
| 1720568637 | Amy Butler | Nurse Practitioner | Blue Ridge Cancer Center, 2955 Research Drive, Blacksburg, VA 24060 | 2018-08-20 |
| 1134615321 | Benjamin Toliver Matthews | Dentist | 1400 S. Main St, Ste 1, Blacksburg, VA 24060 | 2018-07-10 |
| 1881107100 | New River Periodontics and Dental Implant Center, PC | Dentist | 2612 Sheffield Drive, Blacksburg, VA 24060 | 2017-11-08 |
| 1316333685 | Access and Mobility | Durable Medical Equipment & Medical Supplies | 2536 Blossom Trail West, Blackburg, VA 24060 | 2015-04-13 |
| 1326485202 | Kristopher Joel Hansen | Internal Medicine | 2600 Research Center Dr Ste A, Blacksburg, VA 24060 | 2013-05-31 |
| 1891038949 | Holly P. Martin | Physician Assistant | 3706 South Main Street, Suite D, Blacksburg, VA 24060 | 2013-03-27 |
| 1174875330 | Catawba Hospital | Chronic Disease Hospital | 1801 Glade Road, Blacksburg, VA 24060 | 2012-10-11 |
| 1083964316 | Karla Sue Soukup | Marriage & Family Therapist | 510 S. Main Street, Blackburg, VA 24060 | 2012-09-13 |
| Find all providers in zip 24060 | ||||
| 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 |
|---|---|---|---|---|
| 1639160575 | John Marshall Gregg | Dentist | 100 Professional Park Dr Se, Suite 1, Blacksburg, VA 24060-6665 | 2005-10-31 |
| 1013097195 | Nrv Oral & Maxillofacial Surgery, Ltd | Dentist | 100 Professional Park Dr Se, Suite 1, Blacksburg, VA 24060-6665 | 2006-10-16 |
| 1073504882 | Clinton Wilbur Howard IIi | Dentist | 100 Professional Park Dr Se, Suite 1, Blacksburg, VA 24060-6665 | 2005-11-01 |
| 1316938129 | Richard Prentice Boyle IIi | Dentist | 100 Professional Park Dr Se, Suite 1, Blacksburg, VA 24060-6665 | 2005-11-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366058604 | Sherwood Oral Surgery | Dentist | 174b Executive Dr, Danville, VA 24541-4100 | 2020-09-22 |
| 1295348720 | Virginia Plastic Surgery Institute | Dentist | 1016 N Highland St Ste 131b, Arlington, VA 22201-2112 | 2020-08-25 |
| 1487271334 | Moonlight Oral Surgery Pllc | Dentist | 1210 S Glebe Rd Unit 40580, Arlington, VA 22204-0282 | 2020-06-26 |
| 1942826524 | Mira Dental At Tysons Corner Pllc | Dentist | 8201 Greensboro Dr Ste 710, Mc Lean, VA 22102-3818 | 2020-06-19 |
| 1285296814 | South Riding Oral and Implant Surgery | Dentist | 24805 Pinebrook Rd # 318, Chantilly, VA 20152-4126 | 2019-07-03 |
| 1053971861 | Jennifer Rose Van Hook | Dentist | Vcuhs Dept of Omfs Residency, 980566, 1250 E. Marshall Street, Richmond, VA 23298-0566 | 2019-06-14 |
| 1174093835 | Patriot Oral and Facial Surgery Pllc | Dentist | 121 Bulifants Blvd Ste B, Williamsburg, VA 23188-5736 | 2018-11-26 |
| 1881163699 | Loudoun Center for Oral Surgery, Pllc | Dentist | 46161 Westlake Dr Ste 200, Sterling, VA 20165-5871 | 2018-11-21 |
| 1235628991 | Michael Jonathan Theiss | Dentist | 1250 E Marshall St # 980566, Richmond, VA 23298-5051 | 2018-05-08 |
| 1871957043 | Goodwin Oral & Facial Surgery Pllc | Dentist | 3200 Peoples Dr, Ste 210, Harrisonburg, VA 22801-7631 | 2016-04-13 |
| Find all providers with the same taxonomy | ||||
| City | BLACKSBURG |
| Zip Code | 24060 |
Please comment or provide details below to improve the information on DAVID A. WALLACE, DDS, MS, LTD..
| 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.