DR. JODY PAUL WALLACE (NPI# 1740210103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740210103 |
| Entity Type | Individual |
| Full Name | DR. JODY PAUL WALLACE |
| Credential | D.D.S. |
| Practice Address |
2148 Highway 54 Graham NC 27253 |
| Practice Telephone | 3365783884 |
| Practice Fax Number | 3365783814 |
| Mailing Telephone | 3365783884 |
| Mailing Fax Number | 3365783814 |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
7500 | NC | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 89902J1 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912208620 | Jody Pamela Wallace | Genetic Counselor, MS | 201 Industrial Rd, Suite 410, San Carlos, CA 94070-2396 | 2010-11-11 |
| 1841313590 | Jody Lynn Wallace | Social Worker | 48 N Pleasant St Ste 207, Amherst, MA 01002-1741 | 2007-04-09 |
| Street Address |
2148 HIGHWAY 54 |
| City | GRAHAM |
| State | NC |
| Zip Code | 27253 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508237934 | Jerry Crayle | Dentist | 2148 Highway 54, Jerome Crayle Pllc, Graham, NC 27253 | 2015-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487065918 | Matthew Patrick Ellison | Dentist | 150 West Crescent Square Dr., Graham, NC 27253 | 2014-05-19 |
| 1699057158 | Edna Koko Zamparelli | Pharmacist | 901 South Main St, Graham, NC 27253 | 2011-09-12 |
| 1033429410 | Jennifer Blair Thompson | Pharmacist | 401 S. Main Street, Graham, NC 27253 | 2010-10-19 |
| 1205005105 | Woodard Eye Care Od Pllc | Optometrist | Woodard Eye Care, 304 S Main St, Graham, NC 27253 | 2008-02-25 |
| 1538288063 | David Bower | Physical Therapy Assistant | Rehab & Healthcare Center of Alamance, 779 Woody Dr, Graham, NC 27253 | 2007-03-28 |
| 1255435962 | Don W Noah | Chiropractor | 207 North Marshall Street, Graham, NC 27253 | 2006-09-12 |
| 1871504241 | Jennifer S Gordy | Social Worker | 200 N Main St Fl 3, Graham, NC 27253 | 2006-08-11 |
| 1457397192 | Graham Urgent Care Pa | Clinic/Center | 217 East Elm St, Graham, NC 27253 | 2006-06-21 |
| 1053361931 | Lee Hall Worthington | Counselor | 5628 Old Cherokee Ln, Graham, NC 27253 | 2006-05-11 |
| 1316996028 | Jack H Wolf | Family Medicine | 236 Riverbend Rd, Graham, NC 27253 | 2006-05-09 |
| Find all providers in zip 27253 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487065918 | Matthew Patrick Ellison | Dentist | 150 West Crescent Square Dr., Graham, NC 27253 | 2014-05-19 |
| 1861608036 | John T Chen | Dentist | 10221 198th St E, Graham, WA 98338 | 2007-05-15 |
| 1073729224 | Ojh Clinic #7, Inc. | Dentist | 10221 198th St. E., Graham, WA 98338 | 2007-05-15 |
| 1134344666 | Corlis L Sonnenberg | Dentist | 1317 East St, Graham, TX 76450-4230 | 2007-04-17 |
| 1891816492 | Jamie Beall Epperson | Dentist | 401 Oak St, Graham, TX 76450-2521 | 2007-04-02 |
| 1881715498 | David Lee Scott | Dentist | 901 Austin Rd, Graham, TX 76450-4214 | 2007-04-02 |
| 1023192689 | Wesley Allen Lasater | Dentist | 1804 Highway 16 South, Graham, TX 76450-4608 | 2006-10-24 |
| 1790876464 | Jerome M Crayle | Dentist | 2148 Hwy 54, Graham, NC 27253-0801 | 2006-09-27 |
| 1538265293 | Brian A. Brenneman | Dentist | 608 E Pine St, Graham, NC 27253-3233 | 2006-09-16 |
| 1689682767 | Thomas L. Tate | Dentist | 501 Cliff Dr, Graham, TX 76450-3327 | 2006-08-04 |
| Find all providers in GRAHAM | ||||
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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.