NPIMap

Organization Active NPI

Wilkes Dental Consortium Inc

  • Dentist
  • N Wilkesboro, NC
National Provider Identifier
1184728339
Registry record updated Oct 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
WILKES DENTAL CONSORTIUM INC
Practice address
1915 West Park Dr
Suite 104
N Wilkesboro, NC 28659-3777
Phone
(336) 903-7302
Fax
(336) 903-0464
NPI assigned
Sep 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2007

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

Authorized official

Name
Mr. Jerald H. Atkins
Title
Office Manager
Phone
(336) 903-7302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1915 West Park Dr
Suite 104
N Wilkesboro, NC 28659-3777

Mailing address

1915 West Park Dr
Suite 104
N Wilkesboro, NC 28659-3777
Phone (336) 903-7302

Other identifiers 1

IdentifierTypeStateIssuer
07095OtherNCINSURANCE

Other names 1

  • Wilkes Public Health Dental Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

1915 W Park Dr
Ste 104
North Wilkesboro, NC 28659
Phone (336) 903-7300

Practitioners & affiliated clinicians

Practitioners 8

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": "1157760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193356800000",
    "number": "1184728339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 WEST PARK DR",
            "address_2": "SUITE 104",
            "city": "N WILKESBORO",
            "state": "NC",
            "postal_code": "286593777",
            "telephone_number": "336-903-7302",
            "fax_number": "336-903-0464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 WEST PARK DR",
            "address_2": "SUITE 104",
            "city": "N WILKESBORO",
            "state": "NC",
            "postal_code": "286593777",
            "telephone_number": "336-903-7302",
            "fax_number": "336-903-0464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILKES DENTAL CONSORTIUM INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-09",
        "last_updated": "2007-10-26",
        "status": "A",
        "authorized_official_last_name": "ATKINS",
        "authorized_official_first_name": "JERALD",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "336-903-7302",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE",
            "identifier": "07095",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilkes Public Health Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in N Wilkesboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.

Verify at the official NPI Registry.