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Deactivated NPI 1629145859 Deactivated / Inactive NPI Male Practitioner

Dr. William Wall , DDS

Dentist - General Practice • Charleston, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. William Wall has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 30, 2006
NPI Deactivation Date June 15, 2021
Total Practice Duration ~15 Years of Practice (2006 – 2021)

Professional Overview & Biography Verified Profile Summary

Dr. William Wall, DDS was a registered Dentist - General Practice practicing in Charleston, IL. Throughout an active medical career spanning 15 years, Dr. Wall provided care at the practice location at 903 NORTH 18TH STREET until profile deactivation on 2021-06-15.

Practice Location & Contact Primary Location

Practice Address

903 North 18th Street

Charleston, IL 61920

Telephone 2173487770
Fax 2173489279
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Charleston, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
6 Specialists

Practicing in Charleston, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IL 19A12104

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1265761639

Doctor of Dental Medicine

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated June 15, 2021

Record deactivated on June 15, 2021

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 903 NORTH 18TH STREET, CHARLESTON, IL 61920 (Tel: 2173487770)

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Updated Business Mailing Address July 08, 2007

Registered at 903 NORTH 18TH STREET, CHARLESTON, IL 61920 (Tel: 2173487770)

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Provider Name / Credentials Updated July 08, 2007

Recorded as WILLIAM WALL, DDS

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #19A12104 in IL)

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Initial NPI Registration & Enumeration November 30, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1629145859
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 30, 2006
Last Update: July 08, 2007
Deactivation Date: June 15, 2021

Mailing Address

903 North 18th Street

Charleston, IL 61920

Phone: 2173487770

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.