Robert G Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

24420 Issued in TX

Practice address

12801 Edgemere Blvd # B
Suite 112
El Paso, TX 79938-9500

Phone

(915) 493-6310

NPI assigned

Dec 12, 2006

Sex

Male

Sole proprietor

Yes

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

Opted out of Medicare

Yes, effective Dec 13, 2022 through Dec 13, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: robert.wilson@direct.myhealthep.org

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.

• Smile Center for Kids I PLLC

  • General Practice Dentistry
  • El Paso, TX
  • NPI 1689072233
  NPD Authorized official
• Smile Center for Kids PLLC

  • Dentist
  • El Paso, TX
  • NPI 1144661950
  NPD Authorized official
• General Dentistry 4 Kids-Valencia PLLC

  • General Practice Dentistry
  • Tucson, AZ
  • NPI 1699986356
  NPD (past)

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1649330291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 COEUR CIRCLE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799222132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12801 EDGEMERE BLVD # B",
            "address_2": "SUITE 112",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799389500",
            "telephone_number": "915-493-6310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "24420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200271909",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Wilson
• Lourdes Guzman Wilson, M.A., LPC
• Olivia Wilson
• Rebecca Jean Wilson, LCSW
• Regina Ann Wilson
• Stephanie Wilson
• Tiffanie S Wilson, DMD
• Vivian Wilson
• Julianna Marie Windell, LMSW
• Deana Winfield

• General Practice Dentistry in El Paso, TX
• Providers in El Paso, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.