DR. JEFFREY SAMUEL WALLIS (NPI# 1528371507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528371507 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY SAMUEL WALLIS |
| Credential | D.M.D. |
| Practice Address |
17 W Ormond Ave Cherry Hill NJ 08002-3041 |
| Practice Telephone | 8564284445 |
| Practice Fax Number | 8564284497 |
| Mailing Telephone | 8564284445 |
| Mailing Fax Number | 8564284497 |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2014-10-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
22DI02571301 | NJ | Dental Providers |
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
22DI02571300 | NJ | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DS038160 | PA | Dental Providers |
| Street Address |
17 W ORMOND AVE |
| City | CHERRY HILL |
| State | NJ |
| Zip Code | 08002-3041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649261033 | Matthew Eichen Dmd, Pa | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2005-11-03 |
| 1538573720 | Southern New Jersey Oral Surgery Pa | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2014-06-16 |
| 1225367907 | Shariq A Vazir | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2009-12-09 |
| 1720212558 | William C Klein | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2009-05-07 |
| 1841469806 | Shuaib Malik | Dentist | 17 W Ormond Ave, Oral and Maxillofacial Surgery, Cherry Hill, NJ 08002-3041 | 2008-02-25 |
| 1396942397 | Chandini Hudson | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2007-07-02 |
| 1235145970 | John Soh | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2006-08-01 |
| 1760405575 | Matthew M Eichen | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2006-07-25 |
| 1205866720 | Roger Jeffrey Harris | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649878547 | Rachel J Crutchley | Behavioral Analyst | 923 Haddonfield Road Suite 300, Cherry Hill, NJ 08002 | 2020-10-13 |
| 1356954713 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 650 Garden Park Blvd, Cherry Hill, NJ 08002 | 2020-08-26 |
| 1104483825 | Advocare, LLC | Specialist | 600 West Marlton Pike, Suite C, Cherry Hill, NJ 08002 | 2019-05-29 |
| 1881155299 | Tyesha Thomas | Counselor | 57 Colwick Drive, Suite 120, Cherry Hill, NJ 08002 | 2019-03-28 |
| 1982184479 | Brian Keith Smalls Jr. | Early Intervention Provider Agency | 1701 Bishop View Circle, Cherry Hill, NJ 08002 | 2018-08-15 |
| 1124510094 | Salvatore Montana Messina | Student in an Organized Health Care Education/Training Program | 2250 Chapel Avenue, Suite 100, Cherry Hill, NJ 08002 | 2018-06-05 |
| 1871010397 | Jocelyn Lea Daigle | Counselor | 2201 Chapel Avenue W, Cherry Hill, NJ 08002 | 2017-08-25 |
| 1225559495 | Kennedy Medical Group Practice P.C. | Dietitian, Registered | 2211 Chapel Avenue West, Suite 301, Cherry Hill, NJ 08002 | 2017-06-28 |
| 1245750926 | Casey Rich | Behavioral Analyst | 923 Haddonfield Rd Ste 300, Cherry Hill, NJ 08002 | 2017-06-22 |
| 1790211514 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11 Nevada Ave, Cherry Hill, NJ 08002 | 2017-05-11 |
| Find all providers in zip 08002 | ||||
| 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 |
|---|---|---|---|---|
| 1043215205 | Alan Kleiman | Dentist | 148 Renaissance Dr, Cherry Hill, NJ 08003-5103 | 2005-06-15 |
| 1538573720 | Southern New Jersey Oral Surgery Pa | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2014-06-16 |
| 1730503111 | Precision Oral Surgery LLC | Dentist | 1765 Springdale Rd, Suite C-1, Cherry Hill, NJ 08003-2177 | 2014-02-06 |
| 1225367907 | Shariq A Vazir | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2009-12-09 |
| 1720212558 | William C Klein | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2009-05-07 |
| 1841469806 | Shuaib Malik | Dentist | 17 W Ormond Ave, Oral and Maxillofacial Surgery, Cherry Hill, NJ 08002-3041 | 2008-02-25 |
| 1366658932 | Oral & Maxillofacial Surgery Associates Pa | Dentist | 1910 Route 70 E, Suite 4, Cherry Hill, NJ 08003-2123 | 2007-05-14 |
| 1790854784 | Paul Barton Cohen | Dentist | 1910 Marlton Pike E, Suite 4, Cherry Hill, NJ 08003-2123 | 2006-11-06 |
| 1205866720 | Roger Jeffrey Harris | Dentist | 17 W Ormond Ave, Cherry Hill, NJ 08002-3041 | 2006-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124638861 | Riverside Oral Surgery - Edison | Dentist | 80 Route 27, Edison, NJ 08820-3985 | 2020-08-07 |
| 1881227056 | New Jersey Oral Surgery & Dental Implants LLC | Dentist | 87 Route 520, Morganville, NJ 07751-1241 | 2020-02-17 |
| 1003457441 | Madison Dentistry LLC | Dentist | 268 Main Street, Suite B, Madison, NJ 07940 | 2019-10-07 |
| 1508424284 | Posh Dental LLC | Dentist | 39 Tallman Pl Ste 2, Englewood, NJ 07631-2702 | 2019-05-29 |
| 1124598230 | Jc Oral Health Care Pa | Dentist | 103 Greene St Fl 2, Jersey City, NJ 07302-3868 | 2018-12-01 |
| 1801370366 | Palisades Park Dental P.C. | Dentist | 225 Broad Ave # 102, Palisades Park, NJ 07650-1588 | 2018-09-20 |
| 1881174969 | Bethel Oral Surgery & Implants, PC | Dentist | 1319 Anderson Ave Ste D, Fort Lee, NJ 07024-1734 | 2018-08-17 |
| 1790271641 | Morristown Oral Surgery & Implantology Associates LLC | Dentist | 290 Madison Ave Ste 1, Morristown, NJ 07960-7401 | 2018-07-03 |
| 1255826939 | Riverside Oral Surgery - Livingston | Dentist | 209 S Livingston Ave Ste 2, Livingston, NJ 07039-4042 | 2018-06-26 |
| 1295249456 | Pa Dental LLC | Dentist | 17 Main St Ste 301, Robbinsville, NJ 08691-1401 | 2017-11-27 |
| Find all providers with the same taxonomy | ||||
| City | CHERRY HILL |
| Zip Code | 08002 |
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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.