DR. SAMUEL MOORE WALLDEN D.M.D.
NPI 1811348287
Dentist - General Practice in Rockford, IL

Q: What is Samuel Wallden's NPI number?

The NPI number for Samuel Wallden is 1811348287. It was assigned to this individual provider in the NPPES registry on June 28, 2016.

Q: What is Samuel Wallden's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Samuel Wallden was last updated on June 28, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 28, 2016PECOS Enrolled

6075 VANTAGE PL, ROCKFORD, IL 61107(815) 399-0677 Get Directions Write a Review

NPPES record last updated: June 28, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Samuel Moore Wallden D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SAMUEL MOORE WALLDEN D.M.D. (NPI 1811348287) is an individual general practice provider in Rockford, Illinois, licensed in Illinois (019.030757) and active in the NPI registry since June 2016. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1811348287

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. SAMUEL MOORE WALLDENCredential: D.M.D.

Location Address6075 VANTAGE PLRockford, IL 61107-5905

Mailing Address6075 Vantage PlRockford, IL 61107-5905 · (815) 399-0677

Phone(815) 399-0677

Sole ProprietorNo

Enumeration DateJune 28, 2016

✔ NPI 1811348287 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in IL · 019.030757

Definition

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.

6075 VANTAGE PL, Rockford, IL 61107

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Samuel Moore Wallden D.m.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61107 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KELLY JAMES MOORE DDS

Dentist (General Practice)