GLYNIS DYNEL WALLACE (NPI# 1669779732) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669779732 |
| Entity Type | Individual |
| Full Name | GLYNIS DYNEL WALLACE |
| Credential | D.M.D. |
| Practice Address |
779 W 20th St Apt 7 San Pedro CA 90731-5359 |
| Practice Telephone | 5622211852 |
| Mailing Telephone | 5622211852 |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2011-02-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
37179 | CA | Dental Providers |
| Street Address |
779 W 20TH ST APT 7 |
| City | SAN PEDRO |
| State | CA |
| Zip Code | 90731-5359 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962009464 | Jyoti Patel | Optometrist | 1701 Gaffey St., San Pedro, CA 90731 | 2020-10-07 |
| 1518513183 | Churairat Maffei | Technician | 1305 S Patton Ave, San Pedro, CA 90731 | 2019-08-09 |
| 1326692898 | Lori Marie Kroeker | Counselor | 235 W. 9th St, San Pedro, CA 90731 | 2019-08-01 |
| 1366960783 | Maria Elena Newcomer Dds Inc | Dentist | 847 W. 9th St., San Pedro, CA 90731 | 2017-09-06 |
| 1255875944 | Raymond J Mazuchowski Jr. | Dentist | 697 S Gaffery St, San Pedro, CA 90731 | 2016-12-14 |
| 1700235108 | Redina J Williams | Counselor | 559 W, 9th Street, San Pedro, CA 90731 | 2016-06-07 |
| 1649697764 | Leilani M. Sharpe | Psychiatry & Neurology | 222 W 6th St Ste 400, San Pedro, CA 90731 | 2014-03-26 |
| 1134418882 | Neema Rukiya Hardeman | Pediatrics | 2400 S Pacific Ave Bldg 30, San Pedro, CA 90731 | 2011-04-04 |
| 1477878148 | Karla Vanesa Cehua | Dental Assistant | 423n. Meyler St., San Pedro, CA 90731 | 2010-04-06 |
| 1023258183 | Deborah Anne Allsup | Acupuncturist | 732 W. 9th Street, #202, San Pedro, CA 90731 | 2009-03-03 |
| Find all providers in zip 90731 | ||||
| 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 |
|---|---|---|---|---|
| 1487207700 | Victoria A. Shook, D.d.s., A Professional Corp. | Dentist | 28138 S. Western Ave., San Pedro, CA 90732 | 2019-07-17 |
| 1144771445 | K Javid D.d.s and M Nadi D.d.s Inc | Dentist | 1622 S Gaffey St, Suite #102, San Pedro, CA 90731-4658 | 2016-10-21 |
| 1063898153 | Won Sur Park | Dentist | 531 W 7th St Ste B, San Pedro, CA 90731-3115 | 2015-07-30 |
| 1013150838 | Erika Nakamura Gomez | Dentist | 520 W 7th St, San Pedro, CA 90731-3116 | 2009-04-08 |
| 1548432032 | John J Furesh | Dentist | 530 W 9th Street, San Pedro, CA 90731 | 2008-03-25 |
| 1548431018 | Guillermo Rubiano Dds Inc | Dentist | 844 W 9th St, San Pedro, CA 90731-3604 | 2008-03-12 |
| 1609085133 | Christopher A Iwata | Dentist | 665 W 21st St, Apt 2, San Pedro, CA 90731-5550 | 2007-05-22 |
| 1760518989 | Christopher Jospeh Deledonne | Dentist | 1360 W 6th St Ste 110, San Pedro, CA 90732-3542 | 2007-02-23 |
| 1922133651 | Oscar Eduardo Brandi | Dentist | 842 W 9th St, San Pedro, CA 90731-3604 | 2007-02-22 |
| 1982744843 | Ruth Irene Aramaki | Dentist | 1377 W 6th St, San Pedro, CA 90732-3515 | 2007-02-07 |
| Find all providers in SAN PEDRO | ||||
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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.