Active NPI
Blake Wilde, D.D.S.
- Pediatric Dentistry
- Reno, NV
National Provider Identifier
1366706087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 6270
- Practice address
- 10455 Double R Blvd
Reno, NV 89521-8905 - Phone
- (775) 823-9797
- NPI assigned
- Jun 27, 2012
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 6270 | NV | Primary |
Addresses
Primary practice location
10455 Double R Blvd
Reno, NV 89521-8905
Mailing address
10455 Double R Blvd
Reno, NV 89521-8905
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6270 | NV | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340755200000",
"number": "1366706087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10455 DOUBLE R BLVD",
"city": "RENO",
"state": "NV",
"postal_code": "895218905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10455 DOUBLE R BLVD",
"city": "RENO",
"state": "NV",
"postal_code": "895218905",
"telephone_number": "775-823-9797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDE",
"first_name": "BLAKE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-27",
"last_updated": "2012-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NV",
"license": "6270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reno, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.