Kenneth Byron Wiltbank, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

D7468 Issued in OR

Practice address

320 A Ave
Lake Oswego, OR 97034-3056

Phone

(503) 636-3383

NPI assigned

Jul 16, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1003015496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 A AVENUE",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "97034",
            "telephone_number": "503-636-3383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 A AVE",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970343056",
            "telephone_number": "503-636-3383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILTBANK",
        "first_name": "KENNETH",
        "middle_name": "BYRON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-16",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justine Kyckelhahn Crawford Williams, PSY.D.
• Justyne Williams
• Krystal Williams
• Jeffrey Austin Williamson, D.D.S.
• Kaitlyn Patricia Wilson, SLPA
• Kathryn Wise
• WLM
• David A. Wolf, O.D.
• Womens Imaging and Intervention, LLC
• Hayley Wood

• Dentist in Lake Oswego, OR
• Providers in Lake Oswego, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.