Gene Ray Wilson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

012964 Issued in MO

Practice address

1407 N Westwood Blvd
Poplar Bluff, MO 63901-0157

Phone

(573) 778-3042

Fax

(573) 778-9432

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330560000000",
    "number": "1265527352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157",
            "city": "ELLINGTON",
            "state": "MO",
            "postal_code": "636380157",
            "telephone_number": "573-663-2313",
            "fax_number": "573-663-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639010157",
            "telephone_number": "573-778-3042",
            "fax_number": "573-778-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GENE",
        "middle_name": "RAY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2012-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "012964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "12964",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407270917",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lyntoria Rochelle Williams, LCSW
• Regina Elizabeth Williams, PLPC
• Heath David Willis, A.T.C.
• Heather Wills, MSW, LCSW
• Jerry Dale Wilmath, LCSW LPC
• Isaac Wilson
• Lindsy Wilson
• Karen Winberry
• Carl Kevin Winkle, D.C.
• Autumn Nicole Wiseman

• Dentist in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.