Active NPI
William Wilson
- Dentist
- Fayetteville, AR
National Provider Identifier
1508210949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4147
- Practice address
- 2827 E Millennium PL Ste 3
Fayetteville, AR 72703-6528 - Phone
- (479) 313-7373
- Fax
- (479) 313-7379
- NPI assigned
- Apr 22, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4147 | AR | Primary |
Addresses
Primary practice location
2827 E Millennium PL Ste 3
Fayetteville, AR 72703-6528
Mailing address
2827 E Millennium PL Ste 3
Fayetteville, AR 72703-6528
Phone (479) 313-7373
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160817001796 | AR | Order and Referring Only - Dentist | 1355636218 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4147 | AR | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sequoyah Dental, PLLC | Current | Accepting new patients |
Locations
2827 E Millennium Dr
Ste 3
Fayetteville, AR 72703
Phone (479) 313-7373
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Fayetteville, AR
- NPI 1295373322
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602806400000",
"number": "1508210949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2827 E MILLENNIUM PL STE 3",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727036528",
"telephone_number": "479-313-7373",
"fax_number": "479-313-7379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2827 E MILLENNIUM PL STE 3",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727036528",
"telephone_number": "479-313-7373",
"fax_number": "479-313-7379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "WILLIAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-04-22",
"last_updated": "2020-10-16",
"certification_date": "2020-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "4147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; 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.