Brian Robert Wilde, DMD, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D010529 Issued in AZ

Practice address

1320 W Ina Rd
Tucson, AZ 85704-3115

Phone

(520) 742-1232

Fax

(520) 742-0925

NPI assigned

Jul 15, 2013

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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.

• Wilde Orthodontics, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Tucson, AZ
  • NPI 1407487408
  NPD Authorized official
• Orthodontic Specialists of Tucson, PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Tucson, AZ
  • NPI 1780683060
  NPD (past)

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1083055305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W INA RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857043115",
            "telephone_number": "575-522-1779",
            "fax_number": "520-742-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 W INA RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857043115",
            "telephone_number": "520-742-1232",
            "fax_number": "520-742-0925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "BRIAN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-15",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "D010529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wild West Iup, LLC
• Cecilia Catherine Wild, PHARMD
• John J. Wild Jr., MD
• John James Wild III, M.D.
• Wilde Orthodontics, PLLC
• Wildflower Counseling
• Wildflower Psychiatry PC
• Melinda Wildman, FNP-C
• Autumn Wiley-Hill, PHD
• Travis Wiley

• Orthodontics and Dentofacial Orthopedics Dentistry in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; 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.