Wilsonville Dental Group PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6352 Issued in OR

Legal business name

WILSONVILLE DENTAL GROUP PC

Practice address

29292 SW Town Center Loop E
Wilsonville, OR 97070

Phone

(503) 682-0431

Fax

(503) 682-3873

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

Terrence A Clark, DMD

Title

Owner

Phone

(503) 682-0431

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679621080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29292 SW TOWN CENTER LOOP E",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "97070",
            "telephone_number": "503-682-0431",
            "fax_number": "503-682-3873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29292 SW TOWN CENTER LOOP E",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "97070",
            "telephone_number": "503-682-0431",
            "fax_number": "503-682-3873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSONVILLE DENTAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TERRENCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-682-0431",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6352",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7370",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7842",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Lawrence Williams, PT
• Kelly Willis
• Freedom Wilson
• Wilsonville Chiropractic Clinic, P.C.
• Wilsonville Dental Group
• Wilsonville Healthcare LLC
• Wilsonville Natural Medicine, LLC
• Wilsonville Smiles PC (Wilsonville Smiles Dentistry)
• Wilsonville Vision Center PC
• Windfield Village

• General Practice Dentistry in Wilsonville, OR
• Providers in Wilsonville, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.