Raven N. Wilson, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

31866 Issued in TX

Practice address

6222 Hulen Bend Blvd
Fort Worth, TX 76132-2803

Phone

(817) 546-3335

NPI assigned

Jul 7, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1235512427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6222 HULEN BEND BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761322803",
            "telephone_number": "817-546-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6222 HULEN BEND BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761322803",
            "telephone_number": "817-546-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RAVEN",
        "middle_name": "N.",
        "name_prefix": "Miss",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-07",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "31866",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "31866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Mackenzie Wilson, MS, BCBA
• Marina Lynn Wilson, M.D.
• Meagan Kay Wilson, OTR
• Rachel Elaine Wilson, MS, RD, LD
• Rachel Leigh Wilson, DO
• Rebecca J Wilson, ASLP
• Rebecca Karen Wilson
• Rhonda Wilson, SLP
• Rhys Wilson, LPC
• Rochelle S Wilson

• Pediatric Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.