Christian Patrick Wilson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00011025 Issued in WA

Practice address

1611 Kresky Ave
Suite 118
Centralia, WA 98531-8982

Phone

(360) 736-1114

NPI assigned

Jul 11, 2008

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 14, 2017 through Nov 14, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Wilson & Wilson, DDS PLLC

  • General Practice Dentistry
  • Centralia, WA
  • NPI 1992087282
  NPD (past)

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215734400000",
    "number": "1104080910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 KRESKY AVE",
            "address_2": "SUITE 118",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985318982",
            "telephone_number": "360-736-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 KRESKY AVE",
            "address_2": "SUITE 118",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985318982",
            "telephone_number": "360-736-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHRISTIAN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-11",
        "last_updated": "2008-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00011025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul D Williams, MD
• Bridgette Willing
• Rachel Willson
• Wilson & Wilson, DDS PLLC
• Barry K Wilson, M.D.
• Courtney Paige Wilson
• Jessica Kay Wilson, HM61029496
• Kimberly Michelle Wilson, L.M.P. AND L.A.C.
• Michelle Bergmann Wilson, DDS
• Paula Wilson

• General Practice Dentistry in Centralia, WA
• Providers in Centralia, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.