Active NPI
David Earl Wilson, D.D.S
- Endodontics
- Idaho Falls, ID
National Provider Identifier
1124231261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D8541
- Practice address
- 3335 S Holmes Ave
Idaho Falls, ID 83404-7981 - Phone
- (208) 524-3770
- NPI assigned
- May 7, 2007
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D8541 | OR | Primary |
Addresses
Primary practice location
3335 S Holmes Ave
Idaho Falls, ID 83404-7981
Mailing address
2145 Elkhorn Dr
Eugene, OR 97408-1204
Phone (541) 653-9188
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 |
|---|---|---|---|
| D8541 | OR | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern Idaho Endodontics | Endodontics | Past | Accepting new patients |
| Eugene Endodotics LLC | Endodontics | Past | Accepting new patients |
| Root & Branch Anesthesia P.L.L.C. | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Endodontics
- Eugene, OR
- NPI 1427200138
-
- Endodontics
- Idaho Falls, ID
- NPI 1427618958
-
- General Practice Dentistry
- Idaho Falls, ID
- NPI 1528879129
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194825600000",
"number": "1124231261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2145 ELKHORN DR",
"city": "EUGENE",
"state": "OR",
"postal_code": "974081204",
"telephone_number": "541-653-9188",
"fax_number": "541-345-8037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3335 S HOLMES AVE",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047981",
"telephone_number": "208-524-3770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DAVID",
"middle_name": "EARL",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-07",
"last_updated": "2007-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OR",
"license": "D8541",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.