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

Last updated

May 24, 2011By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rock Dental Missouri LLC

  dba Leap Kids Dental

  • 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

• General Practice Dentistry in Houston, MO
• Providers in Houston, MO by specialty
• 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.