NPIMap

Organization Active NPI

Wilson Dental, PC

  • General Practice Dentistry
  • Rockford, MI
National Provider Identifier
1063667079
Registry record updated Nov 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11866 Issued in MI
Legal business name
WILSON DENTAL, PC
Practice address
610 E. Division
Rockford, MI 49341
Phone
(616) 866-0164
Fax
(616) 866-1804
NPI assigned
Nov 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2008

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

Authorized official

Name
Patti L Silverman
Title
Office Manager
Phone
(616) 866-0164

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 11866 MI Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 18895 MI
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 18655 MI

Addresses

Primary practice location

610 E. Division
Rockford, MI 49341

Mailing address

610 E. Division
Rockford, MI 49341
Phone (616) 866-0164

Other identifiers 1

IdentifierTypeStateIssuer
3047000MedicaidMI

National Provider Directory

National Provider Directory

Locations

610 E Division St
Rockford, MI 49341
Phone (616) 866-0164

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1227052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227052800000",
    "number": "1063667079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 E. DIVISION",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-0164",
            "fax_number": "616-866-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E. DIVISION",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-0164",
            "fax_number": "616-866-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-19",
        "last_updated": "2008-11-19",
        "status": "A",
        "authorized_official_last_name": "SILVERMAN",
        "authorized_official_first_name": "PATTI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "616-866-0164"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "11866",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "18895",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "18655",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3047000",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.