DR. DEDRA DESIREE WALLACE (NPI# 1518057934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518057934 |
| Entity Type | Individual |
| Full Name | DR. DEDRA DESIREE WALLACE |
| Credential | DDS |
| Practice Address |
12711 Fm 1960 Rd W Houston TX 77065-4014 |
| Mailing Address |
2536 Amherst St Houston TX 77005-3207 |
| Practice Telephone | 7134908880 |
| Practice Fax Number | 7134906464 |
| Mailing Telephone | 7134908880 |
| Mailing Fax Number | 7134906464 |
| Enumeration Date | 2006-10-14 |
| Last Update Date | 2012-04-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
24891 | TX | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
DN012272 | GA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TMHP | 203532103 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063810877 | Dedra Wallace | Counselor | 1302 Chinook Ln, Pueblo, CO 81001-1851 | 2014-12-10 |
| Street Address |
12711 FM 1960 RD W |
| City | HOUSTON |
| State | TX |
| Zip Code | 77065-4014 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922482686 | Associates for Dental Health, Pllc | Dentist | 12711 Fm 1960 Rd W, Houston, TX 77065-4014 | 2015-07-13 |
| 1417118530 | Texas Dental Associates, Pa | Dentist | 12711 Fm 1960 Rd W, Houston, TX 77065-4014 | 2008-06-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275184913 | American Med Resources, LLC | Nursing Care | 12811 Azalea Creek Trail, Houston, TX 77065 | 2019-09-24 |
| 1619445210 | Prativa N Bhandari | Nurse Practitioner | 11307 Farm To Market, W #130, Houston, TX 77065 | 2018-11-13 |
| 1215405923 | Nyla Jacobs | Physical Therapist | 11777 Fm 1960 W, Houston, TX 77065 | 2018-11-12 |
| 1437632460 | Jose Milton Hernandez Mercado | Dentist | 12341 Fm 1960 Rd W Ste A, Houston, TX 77065 | 2018-09-14 |
| 1780164285 | Portal Cypress Dentistry & Orthodontics Pllc | Dentist | 11211 North Eldridge Pkwy, Houston, TX 77065 | 2018-08-15 |
| 1710492368 | Monica Zelaya | Counselor | 11919 Leaf Oak Dr, Houston, TX 77065 | 2017-12-05 |
| 1619494077 | Tam-anh Nguyen | Specialist/Technologist | 9827 Chiselhurst Dr., Houston, TX 77065 | 2017-08-26 |
| 1881110211 | Veronica Arceneaux | Home Health Aide | 12436 F M 1960 West, #191, Houston, TX 77065 | 2017-08-17 |
| 1528590288 | Cini John | Nurse Practitioner | 11810 Fm1960 W., Hc Medical Doctors, Pa, Houston, TX 77065 | 2017-03-31 |
| 1205282480 | Christine Pham | Technician, Cardiology | 11240 Fm 1960 West, St 406 - A, Houston, TX 77065 | 2016-05-06 |
| Find all providers in zip 77065 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326647454 | Memorial Dentistry for Kids Pllc | Dentist | 14090 Memorial Dr, Houston, TX 77079-6848 | 2020-10-20 |
| 1104438092 | Sarah Al Kukash | Dentist | 2536 Amherst St Ste A, Houston, TX 77005-3207 | 2020-08-20 |
| 1760041578 | Beloved Dental Pllc | Dentist | 4130 Bellaire Blvd, Suite 214, Houston, TX 77025 | 2019-06-06 |
| 1245894294 | Gac Dental Pllc | Dentist | 9540 South Main St., Ste 100, Houston, TX 77025 | 2019-04-25 |
| 1831679976 | Dentini Pediatric Dentistry | Dentist | 2723 Yale Street, Suite 104, Houston, TX 77008 | 2018-08-17 |
| 1851887848 | Michael Posada Dmd, Pllc | Dentist | 2990 Richmond Ave Ste 170, Houston, TX 77098-3109 | 2018-07-03 |
| 1568955052 | Rm Dental Pllc | Dentist | 6500 North Fwy Ste 124, Houston, TX 77076-2941 | 2018-06-11 |
| 1962991927 | Houston Red Oak Drive Dental, PC | Dentist | 17222 Red Oak Dr Ste 104, Houston, TX 77090-2614 | 2018-05-05 |
| 1669970950 | Houston Pediatric Dental Partners | Dentist | 5252 Westchester St Ste 190, Houston, TX 77005-4144 | 2018-02-01 |
| 1821443771 | Antonio Dario Cardenas | Dentist | 8333 Braesmain Dr Apt 1204, Houston, TX 77025-2944 | 2016-04-28 |
| Find all providers in HOUSTON | ||||
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| 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.