Jack L Wilson, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

M470 Issued in SD

Practice address

1721 S Cleveland Ave
Suite 100
Sioux Falls, SD 57103-5501

Phone

(605) 978-9000

Fax

(605) 978-9009

NPI assigned

Aug 28, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Rachel C Soyland DDS PC

  • Dental Clinic/Center
  • Sioux Falls, SD
  • NPI 1346849411
  NPD (past)

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330992000000",
    "number": "1497949929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 S CLEVELAND AVE",
            "address_2": "SUITE 100",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571035501",
            "telephone_number": "605-978-9000",
            "fax_number": "605-978-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 S CLEVELAND AVE",
            "address_2": "SUITE 100",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571035501",
            "telephone_number": "605-978-9000",
            "fax_number": "605-978-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-28",
        "last_updated": "2012-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "SD",
            "license": "M470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wilson T Asfora, MD, PC
• Wilson-Smith Dental Inc
• Brooke A Wilson, OTD
• Clinton Arlin Wilson, DDS
• Elizabeth Wilson
• Jeremy Paul Wilson
• Kelli J Wilson, AUD
• Leslie J Wilson, CNP
• Lili Wat Wilson, FNP
• Nancy L Wilson, M.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Sioux Falls, SD
• Providers in Sioux Falls, SD by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; 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.