Active NPI
Ryan Patrick Wilson, DDS
- Dentist
- Cleveland, TN
National Provider Identifier
1447503396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9831
- Practice address
- 150 Stuart Xing NE
Cleveland, TN 37312-4065 - Phone
- (423) 476-4160
- NPI assigned
- Oct 16, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 9831 | TN | Primary |
Addresses
Primary practice location
150 Stuart Xing NE
Cleveland, TN 37312-4065
Mailing address
150 Stuart Xing NE
Cleveland, TN 37312-4065
Phone (423) 476-2160
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 |
|---|---|---|---|
| 9831 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Dentistry of Chattanooga, PLLC | Current | Accepting new patients | |
| Pediatric Dentistry of Cleveland, LLC | Past | Accepting new patients |
Locations
150 Stuart Xing NE
Cleveland, TN 37312
Phone (423) 476-2160
Organizations & group practices 2
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.
-
- Pediatric Dentistry
- Cleveland, TN
- NPI 1851655187
-
- Pediatric Dentistry
- Cleveland, TN
- NPI 1770695355
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1447503396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 STUART XING NE",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373124065",
"telephone_number": "423-476-2160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 STUART XING NE",
"city": "CLEVELAND",
"state": "TN",
"postal_code": "373124065",
"telephone_number": "423-476-4160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RYAN",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-16",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "9831",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.