Active NPI
Kathi Ann Wilson, DDS
- Dentist
- Grand Rapids, MI
National Provider Identifier
1144291477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 17948
- Practice address
- 4820 Cascade Rd SE
Grand Rapids, MI 49546-3785 - Phone
- (616) 454-1482
- Fax
- (855) 536-4347
- NPI assigned
- Jan 26, 2006
- Sex
- Female
- 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 | 17948 | MI | Primary |
Addresses
Primary practice location
4820 Cascade Rd SE
Grand Rapids, MI 49546-3785
Mailing address
4820 Cascade Rd SE
Grand Rapids, MI 49546-3785
Phone (616) 454-1482
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Oral Surgery
- Education
- Other, 2000
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4820 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3785
Phone 61678032011
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17948 | MI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilson Dental Care GR PC | Current | Accepting new patients |
Locations
4820 Cascade Rd SE
Grand Rapids, MI 49546
Phone (616) 454-1482
4820 Cascade Rd SE
Ste A
Grand Rapids, MI 49546
Phone (616) 454-1482
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.
-
- General Practice Dentistry
- Grand Rapids, MI
- NPI 1598007379
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741651200000",
"number": "1144291477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4820 CASCADE RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495463785",
"telephone_number": "616-454-1482",
"fax_number": "616-454-4422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4820 CASCADE RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495463785",
"telephone_number": "616-454-1482",
"fax_number": "855-536-4347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KATHI",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-26",
"last_updated": "2025-03-11",
"certification_date": "2025-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "17948",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.