Jarell Lamonz Wilson, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D010564 Issued in AZ

Practice address

103 Medicine Way Rd
Peridot, AZ 85542-5000

Phone

(928) 475-1495

NPI assigned

Aug 22, 2016

Last updated

Jun 12, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• San Carlos Apache Healthcare Corporation

  • Critical Access Hospital Clinic/Center
  • Peridot, AZ
  • NPI 1265813075

  TX

  Medicare reassignment NPD
• Jarell Wilson DDS PLLC

  dba Peaceful Smiles

  • Pediatric Dentistry
  • Sanford, FL
  • NPI 1740137546
  NPD Authorized official
• San Carlos Apache Healthcare Corporation

  dba Clarence Wesley Health Center

  • Clinic/Center
  • Bylas, AZ
  • NPI 1417330713
  NPD

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

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781222400000",
    "number": "1336694116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 S MELLONVILLE AVE",
            "city": "SANFORD",
            "state": "FL",
            "postal_code": "327711453",
            "telephone_number": "843-593-5905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MEDICINE WAY RD",
            "city": "PERIDOT",
            "state": "AZ",
            "postal_code": "855425000",
            "telephone_number": "928-475-1495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1934 E Camelback Rd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850164136",
            "country_code": "US",
            "telephone_number": "602-833-2564",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "360 S Mellonville Ave",
            "address_purpose": "LOCATION",
            "city": "Sanford",
            "state": "FL",
            "postal_code": "327711453",
            "country_code": "US",
            "telephone_number": "480-492-1059",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JARELL",
        "middle_name": "LAMONZ",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-22",
        "last_updated": "2026-06-12",
        "certification_date": "2026-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "AZ",
            "license": "D010564",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "059461",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN31327",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "D010564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela N Tambi, PHARMACIST
• Katherine Elaine Tavares, FNP-BC
• Sabra J Van Orsdol, BSN,RN,PHN
• Mandy Vaughan
• Layla Rose Wall, RD
• Jessica Stella Wirtz, PHARMD

• Pediatric Dentistry in Peridot, AZ
• Providers in Peridot, AZ by specialty
• Pediatric Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2026; 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.