NPIMap

Organization Active NPI

Wilkes Dental Consortium

  • General Practice Dentistry
  • North Wilkesboro, NC
National Provider Identifier
1508380544
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WILKES DENTAL CONSORTIUM
Practice address
1915 W Park Dr Ste 104
North Wilkesboro, NC 28659-3777
Phone
(336) 903-9399
NPI assigned
Aug 1, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dedra Roberts
Title
Front Desk Manager
Phone
(336) 903-9399

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1915 W Park Dr Ste 104
North Wilkesboro, NC 28659-3777

Mailing address

1915 W Park Dr Ste 104
North Wilkesboro, NC 28659-3777
Phone (336) 903-9399

Other identifiers 2

IdentifierTypeStateIssuer
911943799OtherNCNCHC
1962565788MedicaidNC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1501545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1508380544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 W PARK DR STE 104",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593777",
            "telephone_number": "336-903-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 W PARK DR STE 104",
            "city": "NORTH WILKESBORO",
            "state": "NC",
            "postal_code": "286593777",
            "telephone_number": "336-903-9399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILKES DENTAL CONSORTIUM",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-01",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "DEDRA",
        "authorized_official_title_or_position": "FRONT DESK MANAGER",
        "authorized_official_telephone_number": "336-903-9399"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCHC",
            "identifier": "911943799",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962565788",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Wilkesboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.