Active NPI
Jack Anthony Wilson, RDHAP
- Dental Hygienist
- National City, CA
National Provider Identifier
1043216807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- HAP 299
- Practice address
- 2654 Stacey Way
National City, CA 91950-7760 - Phone
- (559) 289-8293
- NPI assigned
- Jun 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | HAP 299 | CA | Primary |
Addresses
Primary practice location
2654 Stacey Way
National City, CA 91950-7760
Mailing address
2654 Stacey Way
National City, CA 91950-7760
Phone (559) 289-8293
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 299 | Other | CA | REGISTERED DENTAL HYGIENIST IN ALTERNATIVE PRACTICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HAP 299 | CA | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405382400000",
"number": "1043216807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2654 STACEY WAY",
"city": "NATIONAL CITY",
"state": "CA",
"postal_code": "919507760",
"telephone_number": "559-289-8293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2654 STACEY WAY",
"city": "NATIONAL CITY",
"state": "CA",
"postal_code": "919507760",
"telephone_number": "559-289-8293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JACK",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "RDHAP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-06-24",
"last_updated": "2014-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "CA",
"license": "HAP 299",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGISTERED DENTAL HYGIENIST IN ALTERNATIVE PRACTICE",
"identifier": "299",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in National City, CA
- Raquel J Willey
- William F Resh MD, Skin & Skin Cancer Medical Group of San Diego, Inc.
- William T Chapman MD Inc
- Maria Helena Williamson, IMF
- Constance Berthea Wilson
- Windsor Care Center National City, Inc
- Winterhaven Emergency Physicians Medical Group Inc
- Allyson A Wolfe, M.D.
- Megan Woods
- Gerald L. Workman, LCSW
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.