Active NPI
Amanda Wilson, DDS
- Dentist
- Montgomery, NY
National Provider Identifier
1306392238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 50058756
- Practice address
- 2134 State Route 208
Montgomery, NY 12549-2613 - Phone
- (845) 457-5763
- NPI assigned
- Aug 31, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 50058756 | NY | Primary |
Addresses
Primary practice location
2134 State Route 208
Montgomery, NY 12549-2613
Mailing address
2134 State Route 208
Montgomery, NY 12549-2613
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50058756 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472601600000",
"number": "1306392238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2134 STATE ROUTE 208",
"city": "MONTGOMERY",
"state": "NY",
"postal_code": "125492613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2134 STATE ROUTE 208",
"city": "MONTGOMERY",
"state": "NY",
"postal_code": "125492613",
"telephone_number": "845-457-5763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "AMANDA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-31",
"last_updated": "2016-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "50058756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.