Alexandra Griffin Wild, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DGD.10574 Issued in SC

Practice address

169 Ashley Ave RM 202
Charleston, SC 29425-8905

Phone

(843) 792-7365

NPI assigned

Jun 15, 2021

Last updated

Feb 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Alexandra Griffin Schutter Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708819200000",
    "number": "1316515307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 ASPEN WAY",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551181750",
            "telephone_number": "651-815-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE RM 202",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-792-7365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "ALEXANDRA",
        "middle_name": "GRIFFIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-15",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14619",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "DGD.10574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agw204@musc.edu",
            "affiliation": "N",
            "address_1": "169 Ashley Ave Rm 202",
            "city": "Charleston",
            "state": "SC",
            "country_code": "US",
            "postal_code": "294258905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ALEXANDRA",
            "last_name": "SCHUTTER",
            "middle_name": "GRIFFIN",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Justin Wikle, M.D.
• Alexa Ritchie Wilbanks, PA-C
• Sarah Gassman Wilbanks, OTR/L
• Mary Elisheva Wilchanovsky, APRN, WHNP
• Michael David Wilcox, MD
• David Chamberlayne Wilde Jr., MD
• Fredreana Wilder
• Lashana Jonette Wilder, P.A.
• Lauren Elizabeth Wilder, MD
• Rachel Ann Wildman Dellos, DNP APRN-CNP NNP-BC

• Pediatric Dentistry in Charleston, SC
• Providers in Charleston, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.