Jens Wilson, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DD5597 Issued in NM

Practice address

2650 E Pinon Frontage Rd BLDG 200
Farmington, NM 87402-5084

Phone

(505) 599-9359

NPI assigned

Jun 30, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1568089076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4760 N BUTLER AVE STE C",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874010816",
            "telephone_number": "435-459-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 E PINON FRONTAGE RD BLDG 200",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874025084",
            "telephone_number": "505-599-9359"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4760 N Butler Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "NM",
            "postal_code": "874010816",
            "country_code": "US",
            "telephone_number": "505-535-3044",
            "fax_number": "505-325-2532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JENS",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-30",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": "LL-541-20",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NM",
            "license": "DD5597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd E Williams, MD
• Genevieve Willis, FNP-C
• Janet M Wilmes, M.D.
• Anne Jeannette Wilson
• Christianna Wilson
• Joseph A. Wilson, DMD, MSD, LLC
• Mary Louise Wilson, SLP, M.S.-CCC
• Stephanie Ann Wilson
• Madison Paris Wimbish, CPSW, CCSS, LSAA
• James B Winblad, M.D.

• Pediatric Dentistry in Farmington, NM
• Providers in Farmington, NM by specialty
• Pediatric Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; 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.