Active NPI
Joseph Ross Wilson, DDS
- Pediatric Dentistry
- Suffolk, VA
National Provider Identifier
1437250560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 0401412222
- Practice address
- 2999 Corporate Lane, Suite B-9
Suffolk, VA 23434 - Phone
- (757) 922-8110
- Fax
- (757) 922-8184
- NPI assigned
- Sep 25, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401412222 | VA | |
| General Practice Dentistry | 1223G0001X | D12307 | MN | |
| Pediatric Dentistry | 1223P0221X | 0401412222 | VA | Primary |
Addresses
Primary practice location
2999 Corporate Lane, Suite B-9
Suffolk, VA 23434
Mailing address
2999 Corporate Lane, Suite B-9
Suffolk, VA 23434
Phone (757) 922-8110
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 |
|---|---|---|---|
| D12307 | MN | MD | General Practice Dentistry |
| 0401412222 | VA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559865600000",
"number": "1437250560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2999 CORPORATE LANE, SUITE B-9",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "23434",
"telephone_number": "757-922-8110",
"fax_number": "757-922-8184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2999 CORPORATE LANE, SUITE B-9",
"city": "SUFFOLK",
"state": "VA",
"postal_code": "23434",
"telephone_number": "757-922-8110",
"fax_number": "757-922-8184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JOSEPH",
"middle_name": "ROSS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2019-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401412222",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D12307",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "VA",
"license": "0401412222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Suffolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.