Marc W Wild DDS Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

2466 Issued in WV

Legal business name

MARC W WILD DDS INC

Practice address

1104 5TH Ave
Huntington, WV 25701-2205

Phone

(304) 523-8671

Fax

(304) 523-8674

NPI assigned

Apr 26, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Marc William Wild, DDSNPI 1912916180

Title

President

Phone

(304) 523-8671

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marc William Wild, D.D.S.

  • General Practice Dentistry
  • Huntington, WV
  • NPI 1912916180
  NPD (past) Authorized official

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

{
    "created_epoch": "1209168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209168000000",
    "number": "1487829800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 5TH AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257012205",
            "telephone_number": "304-523-8671",
            "fax_number": "304-523-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 5TH AVE",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257012205",
            "telephone_number": "304-523-8671",
            "fax_number": "304-523-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARC W WILD DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-26",
        "last_updated": "2008-04-26",
        "status": "A",
        "authorized_official_last_name": "WILD",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-523-8671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WV",
            "license": "2466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0136461000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Serena Mansoor, STUDENT
• Mina Mansour, MD
• Kenneth L Mapes, MD
• Hamza Maqbool, MD
• Samantha Maryann Maracle
• Heidi Emma Marchal, PT
• Ashlyn Rose Marcum
• Bobby Lee Marcum, C-FNP
• Brandon Marcum
• Brenda L Marcum, P.T.

• Dental Clinic/Center in Huntington, WV
• Providers in Huntington, WV by specialty
• Dental Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2008; 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.