Michael D Wilson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4288 Issued in NV

Practice address

4230 E Charleston Blvd
Suite B
Las Vegas, NV 89104-2387

Phone

(702) 459-7446

Fax

(702) 459-8078

NPI assigned

Mar 6, 2009

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 NV

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

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236297600000",
    "number": "1043450869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4230 E CHARLESTON BLVD",
            "address_2": "SUITE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891042387",
            "telephone_number": "702-459-7446",
            "fax_number": "702-459-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4230 E CHARLESTON BLVD",
            "address_2": "SUITE B",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891042387",
            "telephone_number": "702-459-7446",
            "fax_number": "702-459-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-06",
        "last_updated": "2009-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "4288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marla Lynn Wilson
• Marta A. T. Wilson, MFT, CPC, LCADC
• Mary Hayden Wilson, BSW,
• Matthew Joseph Wilson, D.D.S.
• Michael Wilson
• Michelle Wilson
• Mickenzie Farrell Wilson, MS, OTR/L
• Mika Wilson
• Mildred Wilson
• Monisha Wilson, RN

• General Practice Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.