Active NPI
Sandra Wilson, DDS
- Dentist
- Fort Washakie, WY
National Provider Identifier
1235348962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5561
- Practice address
- 29 Black Coal Drive
Fort Washakie, WY 82514 - Phone
- (307) 332-7300
- NPI assigned
- May 21, 2007
- Last updated
- Jun 8, 2018
- Sex
- Female
- 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 | 5561 | OK | Primary |
Addresses
Primary practice location
29 Black Coal Drive
Fort Washakie, WY 82514
Mailing address
100 Cheyenne Avenue
Lame Deer, MT 59043-0070
Other practice location 1
100 Cheyenne Avenue
Lame Deer, MT 59043-0070
Phone (406) 477-4464
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| US Health Dept of Health & Human Services | Current | Accepting new patients | |
| U S Health Dept of Health & Human Services | Current | Accepting new patients |
Locations
669 Agency Main St
Harlem, MT 59526
Phone (406) 353-3100
Interoperability endpoints
- sandra.wislon.p1@direct.toiyabe.nextgenshare.com
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federal Public Health Clinic/Center
- Fort Washakie, WY
- NPI 1023174299
-
dba Lodge Grass Clinic
- Critical Access Hospital
- Lodge Grass, MT
- NPI 1750410395
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528416000000",
"number": "1235348962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 CHEYENNE AVENUE",
"city": "LAME DEER",
"state": "MT",
"postal_code": "590430070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 BLACK COAL DRIVE",
"city": "FORT WASHAKIE",
"state": "WY",
"postal_code": "82514",
"telephone_number": "307-332-7300"
}
],
"practiceLocations": [
{
"address_1": "100 Cheyenne Avenue",
"address_purpose": "LOCATION",
"city": "Lame Deer",
"state": "MT",
"postal_code": "590430070",
"country_code": "US",
"telephone_number": "406-477-4464",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "SANDRA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2018-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "5561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Washakie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.