WALLACE CARRILLO-MEDINA DMD MS PA (NPI# 1689290173) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689290173 |
| Entity Type | Organization |
| Organization Name | WALLACE CARRILLO-MEDINA DMD MS PA |
| Practice Address |
511 Greensboro St Asheboro NC 27203-4736 |
| Practice Telephone | 3366293112 |
| Practice Fax Number | 3366294251 |
| Mailing Telephone | 3366293112 |
| Mailing Fax Number | 3366294251 |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2020-06-19 |
| Authorized Official Name | DR. WALLACE C CARRILLO-MEDINA (PRESIDENT) |
| Authorized Official Telephone | 3366293112 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X2210X |
| Street Address |
511 GREENSBORO ST |
| City | ASHEBORO |
| State | NC |
| Zip Code | 27203-4736 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558649947 | Wallace C. Carrillo-medina | Dentist | 511 Greensboro St, Asheboro, NC 27203-4736 | 2011-08-02 |
| 1558869917 | Wallace Carrillo-medina Dmd Pa | Clinic/Center | 511 Greensboro St, Asheboro, NC 27203-4736 | 2018-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609490382 | Brooke Martin Shaw | Nurse Practitioner | 5514, 350 N Cox St, Ste 6, Asheboro, NC 27203 | 2020-05-29 |
| 1689151912 | Earth Angels Home Care | In Home Supportive Care | 167 Macarthur St., Asheboro, NC 27203 | 2018-07-19 |
| 1518485333 | Katherine Hall Kruppenbach | Nurse Practitioner | 223 W Ward St Ste B, Asheboro, NC 27203 | 2017-08-31 |
| 1912429705 | Julie Yates Allsbrook | Pharmacist | 363 Sunset Avenue, Asheboro, NC 27203 | 2017-07-12 |
| 1932651452 | Joshua Knight | Physician Assistant | 197 Nc-42, Asheboro, NC 27203 | 2016-11-01 |
| 1053862391 | Jamie Lauren Webb | Physician Assistant | 197 North Carolina 42 East, White Oak Urgent Care, Asheboro, NC 27203 | 2016-10-21 |
| 1780936146 | Randolph County Senior Adults Association, Inc. | Non-emergency Medical Transport (VAN) | 133 West Wainman Ave., Asheboro, NC 27203 | 2012-10-10 |
| 1730472515 | Maggie Wright Fetner | Dentist | 202 N. Cox St, Asheboro, NC 27203 | 2011-05-26 |
| 1144528944 | Central Piedmont Surgery Center LLC | Clinic/Center | 724 Thomas Street, Asheboro, NC 27203 | 2011-03-03 |
| 1669785614 | Easter Seals Ucp North Carolina & Virginia, Inc. | Case Management | 624 S Fayetteville St, Suite E, Asheboro, NC 27203 | 2010-07-20 |
| Find all providers in zip 27203 | ||||
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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.