Active NPI
Jonathan Adam Wilson, DDS
- Dentist
- Mansfield, OH
National Provider Identifier
1619316866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30023984
- Practice address
- 1221 S Trimble Rd Ste C1
Mansfield, OH 44907-2211 - Phone
- (419) 756-4000
- NPI assigned
- Jun 20, 2013
- 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 | 30023984 | OH | Primary |
Addresses
Primary practice location
1221 S Trimble Rd Ste C1
Mansfield, OH 44907-2211
Mailing address
1221 S Trimble Rd Ste C1
Mansfield, OH 44907-2211
Phone (419) 756-4000
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 |
|---|---|---|---|
| 30023984 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663718400000",
"number": "1619316866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1221 S TRIMBLE RD STE C1",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449072211",
"telephone_number": "419-756-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 S TRIMBLE RD STE C1",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449072211",
"telephone_number": "419-756-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JONATHAN",
"middle_name": "ADAM",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-20",
"last_updated": "2022-09-21",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30023984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 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.