Active NPI
Kenneth Robert Wilson, DDS
- Dentist
- Aurora, CO
National Provider Identifier
1508873373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- CO105011
- Practice address
- 13764 E Quincy Ave
Aurora, CO 80015-1129 - Phone
- (303) 690-0877
- Fax
- (303) 690-1250
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- No
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 | CO105011 | CO | Primary |
Addresses
Primary practice location
13764 E Quincy Ave
Aurora, CO 80015-1129
Mailing address
13764 E Quincy Ave
Aurora, CO 80015-1129
Phone (303) 690-0877
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO105011 | CO | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Signature Dentistry of Aurora | Dentist | Past | Accepting new patients |
| Grady Randall PLLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Aurora, CO
- NPI 1649512849
-
- Dentist
- Aurora, CO
- NPI 1477092500
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508873373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13764 E QUINCY AVE",
"city": "AURORA",
"state": "CO",
"postal_code": "800151129",
"telephone_number": "303-690-0877",
"fax_number": "303-690-1250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13764 E QUINCY AVE",
"city": "AURORA",
"state": "CO",
"postal_code": "800151129",
"telephone_number": "303-690-0877",
"fax_number": "303-690-1250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KENNETH",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "CO105011",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.