Active NPI
Dustin C Wilson, DDS, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Jefferson City, MO
National Provider Identifier
1346521028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2009013246
- Practice address
- 748 W Stadium Blvd
Suite 102
Jefferson City, MO 65109-4752 - Phone
- (573) 634-5122
- NPI assigned
- Sep 8, 2011
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2009013246 | MO | Primary |
Addresses
Primary practice location
748 W Stadium Blvd
Suite 102
Jefferson City, MO 65109-4752
Mailing address
748 W Stadium Blvd
Suite 102
Jefferson City, MO 65109-4752
Phone (573) 634-5122
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2009013246 | MO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479427200000",
"number": "1346521028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "748 W STADIUM BLVD",
"address_2": "SUITE 102",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651094752",
"telephone_number": "573-634-5122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "748 W STADIUM BLVD",
"address_2": "SUITE 102",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651094752",
"telephone_number": "573-634-5122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DUSTIN",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-08",
"last_updated": "2016-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MO",
"license": "2009013246",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.