Dan R Wilson, DDS
Individual provider Active NPI General Practice Dentistry · Pomeroy, WA
NPI 1346351525 · NPPES record last updated Mar 6, 2019
Key facts
- NPI
- 1346351525
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D1862 (ID)
- Practice address
- 813 1/2 Columbia Street
813 1/2 Columbia #99
Pomeroy, WA 99347 - Phone
- (509) 834-3495
- Fax
- (509) 843-3496
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D1862 | ID | MD | General Practice Dentistry |
| 5974 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dan R Wilson DDS PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5974 | WA | |
| General Practice Dentistry | 1223G0001X | D1862 | ID | Yes |
Addresses
Primary practice location
813 1/2 Columbia Street
813 1/2 Columbia #99
Pomeroy, WA 99347
Mailing address
PO Box 99
Pomeroy, WA 99347-0099
Phone (509) 843-3495
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2074241 | Medicaid | WA |
Other providers in Pomeroy, WA
All providers in Pomeroy, WA · General Practice Dentistry in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.