NPIMap

Organization Active NPI

Greggory S. Wilde, DDS, PS

  • Periodontics
  • Silverdale, WA
National Provider Identifier
1497845523
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
DE00004274 Issued in WA
Legal business name
GREGGORY S. WILDE, DDS, PS
Practice address
3594 NW Lowell St
Silverdale, WA 98383-9116
Phone
(360) 692-0300
Fax
(360) 698-2988
NPI assigned
Oct 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Greggory Wayne Scott Wilde, DDS
Title
President
Phone
(360) 692-0300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PeriodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0300X DE00004274 WA Primary

Addresses

Primary practice location

3594 NW Lowell St
Silverdale, WA 98383-9116

Mailing address

PO Box 1970
Silverdale, WA 98383-1970
Phone (360) 692-0300

National Provider Directory

National Provider Directory

Locations

3594 NW Lowell St
Silverdale, WA 98383
Phone (360) 692-0300

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497845523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1970",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983831970",
            "telephone_number": "360-692-0300",
            "fax_number": "360-698-2988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3594 NW LOWELL ST",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983839116",
            "telephone_number": "360-692-0300",
            "fax_number": "360-698-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGGORY S. WILDE, DDS, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "GREGGORY",
        "authorized_official_middle_name": "WAYNE SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-692-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE00004274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverdale, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.