John a. Wilde D.D.S. Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

05824 Issued in IA

Legal business name

JOHN A. WILDE D.D.S. INC.

Practice address

1626 Morgan St
Keokuk, IA 52632-3424

Phone

(319) 524-1477

Fax

(319) 524-7965

NPI assigned

May 19, 2008

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Becky L Vogel, RDA

Title

Office Assistant

Phone

(319) 524-1477

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1427215441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 MORGAN ST",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526323424",
            "telephone_number": "319-524-1477",
            "fax_number": "319-524-7965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 MORGAN ST",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526323424",
            "telephone_number": "319-524-1477",
            "fax_number": "319-524-7965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN A. WILDE D.D.S. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "VOGEL",
        "authorized_official_first_name": "BECKY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE ASSISTANT",
        "authorized_official_telephone_number": "319-524-1477",
        "authorized_official_credential": "RDA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IA",
            "license": "05824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IOWA DENTAL LICENSE",
            "identifier": "05824",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1089326",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER#",
            "identifier": "38071",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Keokuk, IA
• Providers in Keokuk, IA by specialty
• Specialist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.

Verify at the official NPI Registry.