Loren G. Wilson D.D.S. P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LOREN G. WILSON D.D.S. P.C.

Practice address

1030 4TH St
Eldorado, IL 62930-1702

Phone

(618) 273-9684

Fax

(618) 273-7107

NPI assigned

Feb 9, 2007

Organization subpart

No

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

Authorized official

Name

Loren Wilson, D.D.S.NPI 1407996044

Title

President

Phone

(618) 273-9684

Specialties & licenses 1

Addresses

Practitioners 1

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

• Loren G Wilson, D.D.S.

  • General Practice Dentistry
  • Eldorado, IL
  • NPI 1407996044
  NPD (past) Authorized official

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275674426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 BIXLER RD",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629303786",
            "telephone_number": "618-273-9684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 4TH ST",
            "city": "ELDORADO",
            "state": "IL",
            "postal_code": "629301702",
            "telephone_number": "618-273-9684",
            "fax_number": "618-273-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOREN G. WILSON D.D.S. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "LOREN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-273-9684",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Lee, BS
• John David Lemonds, BA
• Carly Lewis
• Shawn Livers
• Jeanette Long X, LPN
• Stephanie Marie Lynn
• Donna V Mack, RN
• Marion Eye Centers LTD.
• Katie Martin, BA, MHP
• Katherine McCormick Mays

• General Practice Dentistry in Eldorado, IL
• Providers in Eldorado, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.