NPIMap

Organization Active NPI

Wilson Dentistry, Inc.

  • Dentist
  • San Bernardino, CA
National Provider Identifier
1467852269
Registry record updated Dec 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
62234 Issued in NY
Legal business name
WILSON DENTISTRY, INC.
Practice address
1063 N. D St
San Bernardino, CA 92410
Phone
(909) 233-7250
NPI assigned
Aug 28, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2014

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

Authorized official

Name
Karen L Butler
Title
Business Manager
Phone
(607) 238-1280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 62234 NY Primary

Addresses

Primary practice location

1063 N. D St
San Bernardino, CA 92410

Mailing address

1063 N D St
San Bernardino, CA 92410-3539
Phone (909) 233-7250

National Provider Directory

National Provider Directory
Tax ID family
Kien H Nguyen DDS PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418256000000",
    "number": "1467852269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1063 N D ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924103539",
            "telephone_number": "909-233-7250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1063 N. D ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92410",
            "telephone_number": "909-233-7250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON DENTISTRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-28",
        "last_updated": "2014-12-11",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "607-238-1280"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NY",
            "license": "62234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.