Active NPI
Kenneth Dean Wylie, DMD
- Dentist
- McMinnville, OR
National Provider Identifier
1083777981
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D8596
- Practice address
- 325 NE 6TH St
McMinnville, OR 97128-4702 - Phone
- (503) 472-6182
- NPI assigned
- Dec 19, 2006
- Last updated
- Apr 11, 2015
- Sex
- Male
- Sole proprietor
- No
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 | D8596 | OR | Primary |
Addresses
Primary practice location
325 NE 6TH St
McMinnville, OR 97128-4702
Mailing address
325 NE 6TH St
McMinnville, OR 97128-4702
Phone (503) 472-6182
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 |
|---|---|---|---|
| D8596 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428710400000",
"number": "1083777981",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 NE 6TH ST",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971284702",
"telephone_number": "503-472-6182"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 NE 6TH ST",
"city": "MCMINNVILLE",
"state": "OR",
"postal_code": "971284702",
"telephone_number": "503-472-6182"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYLIE",
"first_name": "KENNETH",
"middle_name": "DEAN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2015-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D8596",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.