Owen Dale Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5614 Issued in KY

Practice address

1713 Elizabethtown Rd
Leitchfield, KY 42754-8128

Phone

(270) 259-3003

Fax

(270) 259-5408

NPI assigned

Jul 2, 2007

Last updated

Jul 9, 2007By the provider in NPPES

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

Other identifiers 1

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": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1619174661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 ELIZABETHTOWN RD",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427548128",
            "telephone_number": "270-259-3003",
            "fax_number": "270-259-5408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1713 ELIZABETHTOWN RD",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427548128",
            "telephone_number": "270-259-3003",
            "fax_number": "270-259-5408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "OWEN",
        "middle_name": "DALE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60056140",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Wayne Williams, P.A.
• Kiarra Williams, LPCC
• Tanisha Monique Williams, FNP-C
• Earl Denis Wilson, D.M.D.
• Krista Juliane Wilson, TCADC
• Troy D Wood, D.C.
• Regan Alyssa Woodcock, M.S. CCC-SLP
• Thomas Michael Yerkey, LPA
• Gary E Yochim, DO

• General Practice Dentistry in Leitchfield, KY
• Providers in Leitchfield, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.