Active NPI
William T Wilson, DDS
- General Practice Dentistry
- Fairhope, AL
National Provider Identifier
1407889223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3466
- Practice address
- 108 Professional Park Dr
Fairhope, AL 36532-1922 - Phone
- (251) 928-0620
- Fax
- (251) 928-1359
- NPI assigned
- Jul 7, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3466 | AL | Primary |
Addresses
Primary practice location
108 Professional Park Dr
Fairhope, AL 36532-1922
Mailing address
108 Professional Park Dr
Fairhope, AL 36532-1922
Phone (251) 928-0620
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03142 | Other | AL | BLUE CROSS BLUE SHIELD |
| 1906760 | Other | AL | UNITED CONCORDIA |
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 |
|---|---|---|---|
| 3466 | AL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairhope Dental Associates LLC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Fairhope, AL
- NPI 1043231293
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407889223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 PROFESSIONAL PARK DR",
"city": "FAIRHOPE",
"state": "AL",
"postal_code": "365321922",
"telephone_number": "251-928-0620",
"fax_number": "251-928-1359"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 PROFESSIONAL PARK DR",
"city": "FAIRHOPE",
"state": "AL",
"postal_code": "365321922",
"telephone_number": "251-928-0620",
"fax_number": "251-928-1359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "WILLIAM",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "3466",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "03142",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "1906760",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairhope, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.