Laura Wild, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13419 Issued in MN

Practice address

409 Dunlap St N
Saint Paul, MN 55104-4201

Phone

(651) 290-9200

NPI assigned

Jun 15, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lwild275325@direct.ochin.org

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.

• Wild Family Dentistry PLLC

  • Dental Clinic/Center
  • Mendota Heights, MN
  • NPI 1598458655
  NPD Authorized official
• Paul R Wild DDS PA

  • General Practice Dentistry
  • Mendota Heights, MN
  • NPI 1871155788
  NPD (past)

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

{
    "created_epoch": "1402790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402790400000",
    "number": "1245644590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 DUNLAP ST N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044201",
            "telephone_number": "651-290-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 DUNLAP ST N",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044201",
            "telephone_number": "651-290-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-15",
        "last_updated": "2014-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wild River Services
• Wild River Services Inc
• Wild River Services Inc
• Wild Tree Psychotherapy, LLC
• Diane M Wild, CRNA
• Rebecca Wild Wild, RN
• Bex Wilde
• Morell Marie Wilde
• Wildenauer Chiropractic Clinic LTD
• Ulanda D Wiley, CPRS SUPERVISOR

• General Practice Dentistry in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.