NPIMap

Organization Active NPI

Cristin C Wilson DDS

  • General Practice Dentistry
  • Omaha, NE
National Provider Identifier
1194148312
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5740 Issued in NE
Legal business name
CRISTIN C WILSON DDS
Practice address
11717 Burt St
Suite 100
Omaha, NE 68154-1500
Phone
(402) 492-9476
Fax
(402) 492-9838
NPI assigned
Jan 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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

Authorized official

Name
Mrs. Donna Daubert, CDA
Title
Office Manager
Phone
(402) 492-9476

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 5740 NE Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 7113 NE

Addresses

Primary practice location

11717 Burt St
Suite 100
Omaha, NE 68154-1500

Mailing address

11717 Burt St
Suite 100
Omaha, NE 68154-1500
Phone (402) 492-9476

Other identifiers 1

IdentifierTypeStateIssuer
10026100400MedicaidNE

National Provider Directory

National Provider Directory

Locations

11717 Burt St
Ste 100
Omaha, NE 68154
Phone (402) 492-9476

Practitioners & affiliated clinicians

Practitioners 3

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": "1390435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1194148312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11717 BURT ST",
            "address_2": "SUITE 100",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681541500",
            "telephone_number": "402-492-9476",
            "fax_number": "402-492-9838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11717 BURT ST",
            "address_2": "SUITE 100",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681541500",
            "telephone_number": "402-492-9476",
            "fax_number": "402-492-9838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRISTIN C WILSON DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-23",
        "last_updated": "2014-01-23",
        "status": "A",
        "authorized_official_last_name": "DAUBERT",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "402-492-9476",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CDA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "5740",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "7113",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026100400",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; 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.