Active NPI
Ryan Wiltsie
- Dentist
- Las Vegas, NV
National Provider Identifier
1073174488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7235
- Practice address
- 6180 N Decatur Blvd Ste 100
Las Vegas, NV 89130-1505 - Phone
- (702) 359-3107
- NPI assigned
- Jun 26, 2019
- 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 | 7235 | NV | Primary |
Addresses
Primary practice location
6180 N Decatur Blvd Ste 100
Las Vegas, NV 89130-1505
Mailing address
6180 N Decatur Blvd Ste 100
Las Vegas, NV 89130-1505
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 |
|---|---|---|---|
| 7235 | NV | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Faddis Dentists of North Las Vegas, PC | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Dentists of North Las Vegas
- General Practice Dentistry
- Las Vegas, NV
- NPI 1255866158
Multi-Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1561507200000",
"number": "1073174488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6180 N DECATUR BLVD STE 100",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891301505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6180 N DECATUR BLVD STE 100",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891301505",
"telephone_number": "702-359-3107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILTSIE",
"first_name": "RYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-06-26",
"last_updated": "2019-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist",
"state": "NV",
"license": "7235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.