Wyatt William Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D10058 Issued in OR

Practice address

19029 Beavercreek Rd
Oregon City, OR 97045-9537

Phone

(503) 941-3064

Fax

(503) 941-3075

NPI assigned

Jun 23, 2014

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

Other identifiers 1

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neighborhood Health Center

  • Federally Qualified Health Center (FQHC)
  • Portland, OR
  • NPI 1174820815
  NPD (past)
• Neighborhood Health Center

  • Federally Qualified Health Center (FQHC)
  • Oregon City, OR
  • NPI 1699045872

  General Practice

  NPD (past)
• Neighborhood Health Center

  • Federally Qualified Health Center (FQHC)
  • Milwaukie, OR
  • NPI 1750729257

  General Practice

  NPD (past)

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587340800000",
    "number": "1023423639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7320 SW HUNZIKER RD STE 300",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972232302",
            "telephone_number": "503-941-3077",
            "fax_number": "503-747-7013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19029 BEAVERCREEK RD",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970459537",
            "telephone_number": "503-941-3064",
            "fax_number": "503-941-3075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18650 NW Cornell Rd",
            "address_purpose": "LOCATION",
            "city": "Hillsboro",
            "state": "OR",
            "postal_code": "971249207",
            "country_code": "US",
            "telephone_number": "503-848-5861",
            "fax_number": "503-848-5863",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3300 SE Dwyer Dr Ste 302",
            "address_purpose": "LOCATION",
            "city": "Milwaukie",
            "state": "OR",
            "postal_code": "972226548",
            "country_code": "US",
            "telephone_number": "503-850-4479",
            "fax_number": "503-850-4481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WYATT",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D10058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500675716",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caitlin Wilson, EFDA
• Jean M Wilson
• Justin Wilson, BS QP
• Pamela Darlene Wilson, LMT
• Stefanie Kay Wilson
• Robyn R Winden, RPH
• Jon Martin Winjum, MD
• Amy N Winter, PA-C
• Charlene Joyce Wipff
• Elizabeth Shannon Wiseman, LPC

• General Practice Dentistry in Oregon City, OR
• Providers in Oregon City, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2020; 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.