Tyler Craig Wildey, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

27458 Issued in TX

Practice address

711 W 38TH St
Suite a-1
Austin, TX 78705-1121

Phone

(512) 498-0104

Fax

(512) 498-0150

NPI assigned

Oct 4, 2012

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2024 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491696000000",
    "number": "1629320353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W 38TH ST",
            "address_2": "SUITE A-1",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051121",
            "telephone_number": "512-498-0104",
            "fax_number": "512-498-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W 38TH ST",
            "address_2": "SUITE A-1",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051121",
            "telephone_number": "512-498-0104",
            "fax_number": "512-498-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDEY",
        "first_name": "TYLER",
        "middle_name": "CRAIG",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-04",
        "last_updated": "2017-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "27458",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TX",
            "license": "0",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alfred Christian Wilder, MD
• Andrea Wilder
• Justin Wilder, RN
• Katharina Ingeborg Leonore Wilder, APRN-C
• Olivia Jo Wilder, ANP
• Wildflower Pediatrics, PA
• Wildflower Psychotherapy PLLC
• Lindsey Wiley
• Sarah Elizabeth Wiley
• Corby Wilfley

• Dentist in Austin, TX
• Providers in Austin, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.