Active NPI
Tyler J Wilson, DMD
- Dentist
- Central Point, OR
National Provider Identifier
1437568169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D10115
- Practice address
- 4940 Hamrick Rd
Central Point, OR 97502-3072 - Phone
- (541) 690-3600
- Fax
- (541) 664-3735
- NPI assigned
- Aug 6, 2014
- Last updated
- Apr 14, 2020
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D10115 | OR | Primary |
Addresses
Primary practice location
4940 Hamrick Rd
Central Point, OR 97502-3072
Mailing address
931 Chevy Way
Medford, OR 97504-4127
Phone (541) 690-3555
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150909000699 | OR | Order and Referring Only - Dentist | 5799091674 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586822400000",
"number": "1437568169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "931 CHEVY WAY",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975044127",
"telephone_number": "541-690-3555",
"fax_number": "541-842-2212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4940 HAMRICK RD",
"city": "CENTRAL POINT",
"state": "OR",
"postal_code": "975023072",
"telephone_number": "541-690-3600",
"fax_number": "541-664-3735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "TYLER",
"middle_name": "J",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-06",
"last_updated": "2020-04-14",
"certification_date": "2020-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D10115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Central Point, OR
- Margaret Wiencek Alig
- Dale Ross Wilkerson, PHARMD
- Willow Creek Healthcare LLC (Signature Healthcare at Home)
- Willow Creek Healthcare LLC (Signature Healthcare at Home)
- Willow Creek Healthcare LLC (Signature Healthcare at Home)
- Tyler Scott Wise
- Wende Rene Wolfe, LPC
- Wolverine Hearing Group, LLC
- Daniel Phillip Wood, DO
- Heather Wood, RN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.