Gavin B Wilson, DDS
Individual provider Active NPI General Practice Dentistry · Raton, NM
NPI 1013445386 · NPPES record last updated May 31, 2017
Key facts
- NPI
- 1013445386
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DD4693 (NM)
- Practice address
- 217 York Canyon Rd
Raton, NM 87740-2008 - Phone
- (575) 445-8370
- NPI assigned
- May 31, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190116003819 | NM | Order and Referring Only - Dentist |
6406192152 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD4693 | NM | Yes |
Addresses
Primary practice location
217 York Canyon Rd
Raton, NM 87740-2008
Mailing address
217 York Canyon Rd
Raton, NM 87740-2008
Other providers in Raton, NM
- Crystal Dawn Washburn
- Heather Welborn
- Well Care Transport LLC.
- Stanley White
- Michelle Lynn Wilkins
- Jennifer Nicole Wilson
- Troy L Wilson
- Gregory L. Wiltfang
- Tropha A Wright
- Hugh Yardis
All providers in Raton, NM · General Practice Dentistry in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.