Shan Christopher Wilson, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2011014268 Issued in MO

Practice address

321 S 2ND St
Houston, MO 65483-1424

Phone

(417) 967-4528

NPI assigned

May 24, 2011

Sex

Male

Sole proprietor

No

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 MO

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

Practice roles

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.

• Rock Dental Missouri LLC

  • Dentist
  • West Plains, MO
  • NPI 1972014504
  NPD (past)

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306195200000",
    "number": "1487947545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 S 2ND ST",
            "city": "HOUSTON",
            "state": "MO",
            "postal_code": "654831424",
            "telephone_number": "417-967-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 S 2ND ST",
            "city": "HOUSTON",
            "state": "MO",
            "postal_code": "654831424",
            "telephone_number": "417-967-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHAN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-24",
        "last_updated": "2011-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2011014268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa Wells
• Louise Wilkinson, DO
• Wilson Family Chiropractic, LLC
• Darlene Lynn Wilson, LPC
• Kalenna Jean Wilson, D.C.
• Womack Chiropractic Center, PC
• William C. Wright, M.D.
• Jamal A Zereik, MD

• All providers in Houston, MO
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; 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.