Active NPI
Gregg A Wilson, DDS
- Dentist
- Boise, ID
National Provider Identifier
1164516225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D3535
- Practice address
- 10497 Garverdale Court
Suite 107
Boise, ID 83704 - Phone
- (208) 375-5720
- Fax
- (208) 323-8538
- NPI assigned
- Oct 3, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D3535 | ID | Primary |
Addresses
Primary practice location
10497 Garverdale Court
Suite 107
Boise, ID 83704
Mailing address
10497 Garverdale Court
Suite 107
Boise, ID 83704
Phone (208) 375-5720
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 |
|---|---|---|---|
| D3535 | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wilson Dental PLLC | Past | Accepting new patients |
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.
-
- Dental Clinic/Center
- Boise, ID
- NPI 1265935902
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164516225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10497 GARVERDALE COURT",
"address_2": "SUITE 107",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-375-5720",
"fax_number": "208-323-8538"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10497 GARVERDALE COURT",
"address_2": "SUITE 107",
"city": "BOISE",
"state": "ID",
"postal_code": "83704",
"telephone_number": "208-375-5720",
"fax_number": "208-323-8538"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "GREGG",
"middle_name": "A",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D3535",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.