Active NPI
Douglas Armin Wild Sr., DDS
- Dentist
- Burlington, WI
National Provider Identifier
1063677334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4001948E
- Practice address
- 2545 Partridge WDS. CT.
Burlington, WI 53105 - Phone
- (262) 248-3934
- NPI assigned
- Jul 25, 2008
- Last updated
- Jul 25, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 4001948E | WI | Primary |
Addresses
Primary practice location
2545 Partridge WDS. CT.
Burlington, WI 53105
Mailing address
2545 Partridge WDS. CT.
Burlington, WI 53105
Phone (262) 248-3934
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 |
|---|---|---|---|
| 4001948E | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216944000000",
"number": "1063677334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2545 PARTRIDGE WDS. CT.",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "53105",
"telephone_number": "262-248-3934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2545 PARTRIDGE WDS. CT.",
"city": "BURLINGTON",
"state": "WI",
"postal_code": "53105",
"telephone_number": "262-248-3934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILD",
"first_name": "DOUGLAS",
"middle_name": "ARMIN",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-25",
"last_updated": "2008-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "4001948E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.