NPIMap

Organization Active NPI

Fulton Dental Associates PC

  • Dentist
  • Fulton, IL
National Provider Identifier
1154590040
Registry record updated Sep 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
FULTON DENTAL ASSOCIATES PC
Practice address
1130 17TH St
Fulton, IL 61252-2008
Phone
(815) 589-4007
Fax
(815) 589-4897
NPI assigned
Feb 25, 2008
Last updated
Sep 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. William Michael Wilkin, D.D.S.NPI 1982776621
Title
Owner
Phone
(815) 589-4007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

1130 17TH St
Fulton, IL 61252-2008

Mailing address

1130 17TH St
Fulton, IL 61252-2008
Phone (815) 589-4007

Other identifiers 2

IdentifierTypeStateIssuer
1004473MedicaidIL
1004190MedicaidIL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222128000000",
    "number": "1154590040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 17TH ST",
            "city": "FULTON",
            "state": "IL",
            "postal_code": "612522008",
            "telephone_number": "815-589-4007",
            "fax_number": "815-589-4897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 17TH ST",
            "city": "FULTON",
            "state": "IL",
            "postal_code": "612522008",
            "telephone_number": "815-589-4007",
            "fax_number": "815-589-4897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULTON DENTAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2008-09-23",
        "status": "A",
        "authorized_official_last_name": "WILKIN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-589-4007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004473",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004190",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fulton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2008; 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.