Spencer Grant Wilson, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D0020739 Issued in TX

Practice address

1355 S Higley Rd
106
Gilbert, AZ 85296-4799

Phone

(480) 279-5949

Fax

(480) 279-0784

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Mar 22, 2016 through Mar 22, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1386676922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 S HIGLEY RD",
            "address_2": "106",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964799",
            "telephone_number": "480-279-5949",
            "fax_number": "480-279-0784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 S HIGLEY RD",
            "address_2": "106",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852964799",
            "telephone_number": "480-279-5949",
            "fax_number": "480-279-0784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SPENCER",
        "middle_name": "GRANT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "D0020739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502262",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Wilson, COTA/L
• Jennifer C Wilson, PT
• Justin Wilson, PT
• Melisa Ann Wilson, COTA/L
• Ralph Valentine Wilson, M.D.
• Deborah A. Wilton
• Lawrence Winberry III
• Kelly M Winchester Povar, RDH
• Morgan Winder
• Windhorse Counseling

• Oral and Maxillofacial Surgery (Dentist) in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.