Individual provider Active NPI

Lois S Wilson, D.D.S.

  • General Practice Dentistry
  • MC Lean, VA
National Provider Identifier
1336352236
Registry record updated Nov 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
8615 Issued in VA
Practice address
1447 Dolley Madison Blvd Ste C
MC Lean, VA 22101-6041
Phone
(703) 457-1147
Fax
(703) 884-1504
NPI assigned
May 7, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 9, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 16168 MD
General Practice Dentistry 1223G0001X 8615 VA Primary

Addresses

Primary practice location

1447 Dolley Madison Blvd Ste C
MC Lean, VA 22101-6041

Mailing address

25 Oakdale CT
Sterling, VA 20165-5642
Phone (703) 919-2506

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20170824002293 VA Order and Referring Only - DentistPractitioner - Dentist 5799090155

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8615VAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
James T. Planicka, DDS, PC General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541721600000",
    "number": "1336352236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 OAKDALE CT",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201655642",
            "telephone_number": "703-919-2506",
            "fax_number": "703-406-9514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1447 DOLLEY MADISON BLVD STE C",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221016041",
            "telephone_number": "703-457-1147",
            "fax_number": "703-884-1504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LOIS",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2018-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "16168",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "8615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in MC Lean, VA

Sources for this page

Verify at the official NPI Registry.