Lisa Karen Wilde, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

TX17243 Issued in TX

Practice address

1515 E Kearney St Ste 101
Mesquite, TX 75149-2688

Phone

(972) 329-0018

Fax

(972) 329-0019

NPI assigned

Aug 21, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457466013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 W TRINITY ST",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751269561",
            "telephone_number": "972-564-3371",
            "fax_number": "972-329-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E KEARNEY ST STE 101",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751492688",
            "telephone_number": "972-329-0018",
            "fax_number": "972-329-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "LISA",
        "middle_name": "KAREN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "TX17243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vickie White, LPC
• Jordyn Whitley
• Paige Elizabeth Whitlock
• Francis Wiederman, MD
• Wendell Wilcox
• Wilkins and Associates
• Jessica Amber Williams, LCSW
• Jojo Williams
• Kristal Williams
• Lemia Shantel Williams

• General Practice Dentistry in Mesquite, TX
• Providers in Mesquite, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.