Active NPI
Doretha M Wilson
- Dental Hygienist
- Winterhaven, CA
National Provider Identifier
1407554686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 3209
- Practice address
- 401 Picacho Rd
Winterhaven, CA 92283-9605 - Phone
- (760) 572-4811
- NPI assigned
- Feb 17, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 3209 | KY | Primary |
Addresses
Primary practice location
401 Picacho Rd
Winterhaven, CA 92283-9605
Mailing address
PO Box 1368
Yuma, AZ 85366-2361
Phone (760) 572-4137
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 |
|---|---|---|---|
| 3209 | KY | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676592000000",
"number": "1407554686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1368",
"city": "YUMA",
"state": "AZ",
"postal_code": "853662361",
"telephone_number": "760-572-4137",
"fax_number": "760-572-4228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 PICACHO RD",
"city": "WINTERHAVEN",
"state": "CA",
"postal_code": "922839605",
"telephone_number": "760-572-4811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DORETHA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-17",
"last_updated": "2023-02-17",
"certification_date": "2023-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "KY",
"license": "3209",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winterhaven, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.