Angela Wilbert Southwell, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

8834 Issued in TN

Practice address

206 Rivergate Pkwy
Goodlettsville, TN 37072-2033

Phone

(615) 859-9994

NPI assigned

Jan 18, 2006

Sex

Female

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 3

Other names 1

• Angela Idelle Wilbert Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1295715274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 DANWOOD CT",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370756311",
            "telephone_number": "910-603-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 RIVERGATE PKWY",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370722033",
            "telephone_number": "615-859-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHWELL",
        "first_name": "ANGELA",
        "middle_name": "WILBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "8834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15118461",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902819",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "90241",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "WILBERT",
            "middle_name": "IDELLE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dentist in Goodlettsville, TN
• Providers in Goodlettsville, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; 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.