Active NPI
Gary Trent Wilson Jr., D.D.S.
- Dentist
- Memphis, TN
National Provider Identifier
1447581269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS8561
- Practice address
- 6250 Poplar Ave
Memphis, TN 38119-4713 - Phone
- (901) 681-0011
- Fax
- (901) 681-9725
- NPI assigned
- Jan 18, 2010
- 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 | DS8561 | TN | Primary |
Addresses
Primary practice location
6250 Poplar Ave
Memphis, TN 38119-4713
Mailing address
6250 Poplar Ave
Memphis, TN 38119-4713
Phone (901) 681-0011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS8561 | TN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263772800000",
"number": "1447581269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6250 POPLAR AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381194713",
"telephone_number": "901-681-0011",
"fax_number": "901-681-9725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6250 POPLAR AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381194713",
"telephone_number": "901-681-0011",
"fax_number": "901-681-9725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "GARY",
"middle_name": "TRENT",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-18",
"last_updated": "2010-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "DS8561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2010; 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.