Spencer G Wilson DDS PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D0020739 Issued in AZ

Legal business name

SPENCER G WILSON DDS PC

Practice address

1355 S Higley Rd Ste 106
Gilbert, AZ 85296-4799

Phone

(480) 279-5949

Fax

(480) 279-0784

NPI assigned

Jan 9, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Spencer G Wilson, D.D.S

Title

President

Phone

(480) 279-5949

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1199836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199836800000",
    "number": "1013192913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 S HIGLEY RD STE 106",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964799",
            "telephone_number": "480-279-5949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 S HIGLEY RD STE 106",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964799",
            "telephone_number": "480-279-5949",
            "fax_number": "480-279-0784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER G WILSON DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-09",
        "last_updated": "2008-01-09",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "480-279-5949",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D0020739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502262",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.