Wilson Dental PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D35345 Issued in ID

Legal business name

WILSON DENTAL PLLC

Practice address

10497 W Garverdale CT Ste 107
Boise, ID 83704-5468

Phone

(208) 375-5720

Fax

(208) 323-8538

NPI assigned

Mar 8, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Gregg Andrew Wilson, DDSNPI 1164516225

Title

Dentist/Ceo

Phone

(208) 906-0501

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gregg A Wilson, DDS

  • Dentist
  • Boise, ID
  • NPI 1164516225
  NPD (past) Authorized official
• John Thornton Wilson, D.M.D

  • General Practice Dentistry
  • Boise, ID
  • NPI 1386717213
  NPD (past)

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

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520467200000",
    "number": "1265935902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10497 W GARVERDALE CT STE 107",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045468",
            "telephone_number": "208-375-5720",
            "fax_number": "208-323-8538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10497 W GARVERDALE CT STE 107",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045468",
            "telephone_number": "208-375-5720",
            "fax_number": "208-323-8538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-08",
        "last_updated": "2018-03-08",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "DENTIST/CEO",
        "authorized_official_telephone_number": "208-906-0501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D35345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807297400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Summer Wilmot, RN
• Lauren Alexandra Wilmott, DC
• Andrew P Wilper, M.D.
• Halie Sarah Wilsey, LMSW
• Rebecca Lee Wilsey, LSW
• Heidi Renee Wilson Macy
• Ashleigh Wilson
• Audra Lynn Wilson, PAC
• Brian Wilson, PHARM.D.
• Carly J Wilson, MS, LAT, ATC

• Dental Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; 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.