Spencer K. Wilde, DDS

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

D5497 Issued in AZ

Practice address

625 W Southern Ave Ste E-145
Mesa, AZ 85210-5030

Phone

(480) 710-8081

Fax

(866) 814-1886

NPI assigned

Dec 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 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Desert State Dental Anesthesia, LLC

  • Dental Anesthesiology
  • Mesa, AZ
  • NPI 1407994676
  NPD (past)

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467331200000",
    "number": "1295893196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PMB 351",
            "address_2": "6890 E. SUNRISE DR. STE 120",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857500739",
            "telephone_number": "520-730-6467",
            "fax_number": "520-529-2938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 W SOUTHERN AVE STE E-145",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852105030",
            "telephone_number": "480-710-8081",
            "fax_number": "866-814-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "SPENCER",
        "middle_name": "K.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2016-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "AZ",
            "license": "D5497",
            "primary": true
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "TX",
            "license": "25894",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER ID DSDA",
            "identifier": "884644",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS PROVIDER ID",
            "identifier": "863573",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirk Shawgo Wilcox, PHAM. D. , BS
• Paige Wilcox, PSYD
• Terry Sue Wilcox, FNP
• David C Wilcoxson, MD
• Robyn Lynn Wilcoxson, P.T.
• Kalli Wilembrecht, PHARM.D.
• Barbara G Wiles, FNP-BC, MSN, RN
• Joel Wiley, DPT
• Lisa Wiley, RPH
• Lily J Wilhelm, LPC

• Dental Anesthesiology in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Dental Anesthesiology in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2016; 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.