NPIMap

Organization Active NPI

David G Wilson DMD LLC

  • Dentist
  • Selinsgrove, PA
National Provider Identifier
1154773489
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS019605L Issued in PA
Legal business name
DAVID G WILSON DMD LLC
Practice address
1372 N Susquehanna TRL Ste 140
Selinsgrove, PA 17870-8973
Phone
(570) 743-8119
Fax
(570) 743-2009
NPI assigned
Jul 11, 2016
Organization subpart
Yes
Parent organization
DAVID G WILSON DMD LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Authorized official

Name
Dr. David G Wilson, DMDNPI 1992708952
Title
Owner/Orthodontist
Phone
(570) 850-8119

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DS019605L PA Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

1372 N Susquehanna TRL Ste 140
Selinsgrove, PA 17870-8973

Mailing address

1372 N Susquehanna TRL Ste 140
Selinsgrove, PA 17870-8973
Phone (570) 743-8119

Other identifiers 1

IdentifierTypeStateIssuer
7556450001OtherPAMEDICARE DME PTAN NUMBER

Other names 1

  • Wilson Orthodontics Doing business as

National Provider Directory

National Provider Directory
Part of
David G Wilson DMD LLC

Locations

1372 N Susquehanna Trl
Ste 140
Selinsgrove, PA 17870
Phone (570) 743-8119

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1154773489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1372 N SUSQUEHANNA TRL STE 140",
            "city": "SELINSGROVE",
            "state": "PA",
            "postal_code": "178708973",
            "telephone_number": "570-743-8119",
            "fax_number": "570-743-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1372 N SUSQUEHANNA TRL STE 140",
            "city": "SELINSGROVE",
            "state": "PA",
            "postal_code": "178708973",
            "telephone_number": "570-743-8119",
            "fax_number": "570-743-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID G WILSON DMD LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVID G WILSON DMD LLC",
        "enumeration_date": "2016-07-11",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/ORTHODONTIST",
        "authorized_official_telephone_number": "570-850-8119",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS019605L",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME PTAN NUMBER",
            "identifier": "7556450001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilson Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Selinsgrove, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.