Mitchell William Wilbert, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

039265 Issued in NY

Practice address

710 Black River Blvd N
Rome, NY 13440-4328

Phone

(315) 339-5364

Fax

(315) 339-5365

NPI assigned

Jan 17, 2007

Sex

Male

Sole proprietor

Yes

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 NY

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)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013069111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25",
            "city": "WESTERNVILLE",
            "state": "NY",
            "postal_code": "134860025",
            "telephone_number": "315-827-4534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 BLACK RIVER BLVD N",
            "city": "ROME",
            "state": "NY",
            "postal_code": "134404328",
            "telephone_number": "315-339-5364",
            "fax_number": "315-339-5365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBERT",
        "first_name": "MITCHELL",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "039265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara A Welch-Drozd, LMSW/LCSW
• Sabrina Wertz, LPN
• Jennifer Westbrook
• Christine Ann Wheeler, RN
• Samantha White
• Judy Norman Wilburn, FNP
• Mark E Williams, M.D.
• Melissa J Williams, MSPT
• Rich Williams II, RN
• Rosemary Al Williams, LPN

• General Practice Dentistry in Rome, NY
• Providers in Rome, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.