Active NPI
Douglas C. Wilson, DMD
- Dentist
- Aurora, CO
National Provider Identifier
1346235702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 00202173
- Practice address
- 13065 E 17TH Ave
Aurora, CO 80045-2532 - Phone
- (303) 724-7046
- NPI assigned
- Sep 13, 2005
- Sex
- Male
- 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 | 00202173 | CO | Primary |
Addresses
Primary practice location
13065 E 17TH Ave
Aurora, CO 80045-2532
Mailing address
13065 E 17TH Ave
Aurora, CO 80045-2532
Phone (303) 724-7046
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 18, 2020 through Nov 18, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00202173 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595116800000",
"number": "1346235702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13065 E 17TH AVE",
"city": "AURORA",
"state": "CO",
"postal_code": "800452532",
"telephone_number": "303-724-7046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13065 E 17TH AVE",
"city": "AURORA",
"state": "CO",
"postal_code": "800452532",
"telephone_number": "303-724-7046"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DOUGLAS",
"middle_name": "C.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-13",
"last_updated": "2020-07-19",
"certification_date": "2020-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "00202173",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.