MEDICARE: DR. JEFFREY H WALLEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	2959	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497729396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY H WALLEN DDS

Provider Business Mailing Address
First Line	:	1200 48TH AVE N
Second Line	:	SUITE 101
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5425
Country	:	US
Telephone Number	:	843-449-4993
Fax Number	:	843-497-0647

Provider Business Practice Location Address
First Line	:	1200 48TH AVE N
Second Line	:	SUITE 101
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5425
Country	:	US
Telephone Number	:	843-449-4993
Fax Number	:	843-497-0647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

Similar Medicare Providers

1013991199 — MARGARET S BHATT M.D.
Practice Location Address:

1203 48TH AVE N STE 202
MYRTLE BEACH, SC
29577-5425

Practice Phone: 843-449-7105
Practice Fax: 843-449-7105

1720139645 — DR. ADEDAPO M ODUWOLE MD
Practice Location Address:

1203 48TH AVE N , 202
MYRTLE BEACH, SC
29577-5425

Practice Phone: 843-449-2576
Practice Fax: 843-449-6851

1609032630 — MS. PATSY GARDNER ALEXANDER MSW LISW-CP
Practice Location Address:

1203 48TH AVE N , UNIT 202
MYRTLE BEACH, SC
29577-5425

Practice Phone: 843-449-3086
Practice Fax: 843-449-6851

1457592933 — SOUTHERN CROSS PSYCHIATRIC SERVICES OF SOUTH CAROLINA, INC.
Practice Location Address:

1203 48TH AVE N STE 202
MYRTLE BEACH, SC
29577-5425

Practice Phone: 843-449-7105
Practice Fax: 843-449-5090

1144458183 — MOFDAPS AND COMPANY
Practice Location Address:

1203 48TH AVE N , 202
MYRTLE BEACH, SC
29577-5425

Practice Phone: 843-449-2576
Practice Fax: 843-449-6851

1336596733 — MS. VIRGINIA PAGE LPC, MAC, CACII, NCC
Practice Location Address:

1203 48TH AVE N STE 202
MYRTLE BEACH, SC
29577-5425

Practice Phone: 843-267-8885
Practice Fax: 843-449-6851

Directions to “ DR. JEFFREY H WALLEN DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.