Organization Active NPI

West Wilson Dental Group LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mount Juliet, TN
National Provider Identifier
1053584953
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
7268 Issued in TN
Legal business name
WEST WILSON DENTAL GROUP LLC
Practice address
66 E Hill Dr
Suite B
Mount Juliet, TN 37122-8031
Phone
(615) 773-1150
Fax
(615) 773-1110
NPI assigned
Apr 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Authorized official

Name
Dr. Joseph S Doctora, D.D.S., M.D.
Title
Owner
Phone
(615) 773-1150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 7268 TN Primary

Addresses

Primary practice location

66 E Hill Dr
Suite B
Mount Juliet, TN 37122-8031

Mailing address

66 E Hill Dr
Suite B
Mount Juliet, TN 37122-8031
Phone (615) 773-1150

Other identifiers 1

IdentifierTypeStateIssuer
3226329MedicaidTN

National Provider Directory

National Provider Directory

Locations

66 E Hill St
Ste B
Mount Juliet, TN 37122
Phone (615) 773-1150

NPI Registry JSON

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1053584953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 E HILL DR",
            "address_2": "SUITE B",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371228031",
            "telephone_number": "615-773-1150",
            "fax_number": "615-773-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 E HILL DR",
            "address_2": "SUITE B",
            "city": "MOUNT JULIET",
            "state": "TN",
            "postal_code": "371228031",
            "telephone_number": "615-773-1150",
            "fax_number": "615-773-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST WILSON DENTAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "DOCTORA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-773-1150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.D."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "7268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3226329",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Juliet, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.