ASHLEY WALLACE (NPI# 1417466236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417466236 |
| Entity Type | Individual |
| Full Name | ASHLEY WALLACE |
| Credential | DMD |
| Practice Address |
1 Wahoo Ave Groton CT 06349-2324 |
| Practice Telephone | 8606943738 |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2017-09-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
DN1857727 | MA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639669757 | Ashley Wallace | Massage Therapist | 106 Lake Boone Trl Ste B, Raleigh, NC 27608-1052 | 2018-05-14 |
| 1861895203 | Ashley Wallace | Licensed Practical Nurse | 29615 Hanover Blvd, Westland, MI 48186-5179 | 2014-09-30 |
| 1548410863 | Ashley Smith Wallace | Nurse Practitioner | Duke University Hospital South, 200 Trent Drive-clinic 2d, Durham, NC 27710-0001 | 2008-09-23 |
| 1912552035 | Ashley Wailes Wallace | Physical Therapist | 3292 E Willow St, Signal Hill, CA 90755-2309 | 2019-08-06 |
| 1679133573 | Ashley Lynette Wallace | Nurse Practitioner | 1400 8th Ave, Fort Worth, TX 76104-4110 | 2019-06-13 |
| 1972070068 | Ashley Lynne Wallace | Occupational Therapy Assistant | 1000 Us Highway 82 E, Sherman, TX 75090-1704 | 2018-10-27 |
| 1194227744 | Ashley L Wallace | Registered Nurse | 8801 S 101st East Ave, Tulsa, OK 74133 | 2018-02-28 |
| 1942719612 | Ashley Wallace | Peer Specialist | 1219 K St Nw, Ardmore, OK 73401-1801 | 2017-09-26 |
| 1770951394 | Ashley Kathleen Wallace | Behavioral Analyst | 11 Huron Dr, Natick, MA 01760-1336 | 2015-09-14 |
| 1699157099 | Ashley Wallace | Social Worker | 425 Broadway St, Paducah, KY 42001-0713 | 2015-06-22 |
| Street Address |
1 WAHOO AVE |
| City | GROTON |
| State | CT |
| Zip Code | 06349-2324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043207004 | Matthew Braden Burns Miller | Dentist | 1 Wahoo Ave, Groton, CT 06349 | 2005-10-04 |
| 1063027407 | Jimmy Nazih Suliman | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-09-12 |
| 1790395242 | Duc-nhan Nguyen Pham | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-08-08 |
| 1770112708 | Amanda Kathleen Dobyns | Occupational Therapist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-04-02 |
| 1831732825 | Cody Clark | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-10-22 |
| 1477103059 | Jordan Taylor Rucinski | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-09-16 |
| 1699335372 | Cynthia Daigneault | Counselor | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-06-16 |
| 1942868211 | Cameron Anson Martin | Military Health Care Provider | 1 Wahoo Ave, Groton, CT 06340 | 2019-06-03 |
| 1104386903 | Zena Sabath | General Practice | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-03-20 |
| 1538636527 | Winston Eugene Young | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2018-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205434347 | Mvca | Optometrist | Navy Submarine Base New London, Bldg 484, Groton, CT 06349 | 2020-10-12 |
| 1376194274 | Christopher Lee Roy Smith | Military Health Care Provider | Uss San Juan (ssn 751), Groton, CT 06349 | 2019-09-23 |
| 1588127575 | Morgan Ross Jones | Student in an Organized Health Care Education/Training Program | Bx 159 Navsubase Nlon, Groton, CT 06349 | 2019-04-08 |
| 1689179640 | David Saunders | Military Health Care Provider | 159 Navsubase Nlon, Groton, CT 06349 | 2018-03-29 |
| 1013264423 | Dennis Buenaventura Custodio | Military Health Care Provider | 69 Trout Ave, Naval Undersea Medical Institute, Groton, CT 06349 | 2012-08-06 |
| 1609013549 | Nicolas David Mendoza | Military Health Care Provider | Uss Hawaii (ssn 776), Fpo, AE 06349 | 2009-01-14 |
| 1881843084 | Mark Francis Jarvis | Military Health Care Provider | Nssc Nlon, Bldg 76, Groton, CT 06349 | 2008-09-11 |
| 1780882738 | Michael Nutt | Military Health Care Provider | Bldg 517 Taugtog Ave, Navsubscol, Groton, CT 06349 | 2007-07-10 |
| 1497811343 | Keith Benjamin Hoekman | Nurse Practitioner | 1 Wahoo Dr, Groton, CT 06349 | 2006-12-28 |
| 1881604163 | Christina E Toufexis | Pediatrics | 1 Wahoo Drive, Groton, CT 06349 | 2006-08-09 |
| Find all providers in zip 06349 | ||||
| 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 |
|---|---|---|---|---|
| 1306452479 | Robert James Wollschlager | Dentist | 495 Route 184 Ste 312, Groton, CT 06340-6230 | 2020-09-23 |
| 1538674262 | Tercel Dental Pllc | Dentist | 643 Gold Star Hwy., Groton, CT 06340 | 2017-12-04 |
| 1457420770 | Connecticut Dental Groups | Dentist | 1100 Poquonnock Rd, Groton, CT 06340 | 2006-11-08 |
| 1740379635 | John Joseph Widlak Jr. | Dentist | 163 Ledgewood Rd, Apt 412, Groton, CT 06340-6611 | 2006-10-11 |
| 1063512853 | J Michael Tiberii | Dentist | 643 Route 184, Groton, CT 06340 | 2006-09-22 |
| 1497866875 | Jennifer Lee Mackey | Dentist | 423 Long Hill Rd, Groton, CT 06340-3812 | 2006-08-31 |
| 1043207004 | Matthew Braden Burns Miller | Dentist | 1 Wahoo Ave, Groton, CT 06349 | 2005-10-04 |
| 1336141068 | John M Johnson | Dentist | 643 Gold Star Hwy, Groton, CT 06340-6267 | 2005-08-12 |
| 1063027407 | Jimmy Nazih Suliman | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-09-12 |
| 1790395242 | Duc-nhan Nguyen Pham | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-08-08 |
| Find all providers in GROTON | ||||
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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.