Active NPI
Robert Carl Wilde, DMD
- Dentist
- Newberg, OR
National Provider Identifier
1710097514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D5798
- Practice address
- 201 N Washington St
Newberg, OR 97132-2727 - Phone
- (503) 538-2560
- NPI assigned
- Aug 30, 2006
- 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 | D5798 | OR | Primary |
Addresses
Primary practice location
201 N Washington St
Newberg, OR 97132-2727
Mailing address
14800 SW Bull Mountain Rd
Tigard, OR 97224-1233
Phone (503) 590-1480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150624001562 | OR | Practitioner - Other (Non-Physician) | 9032420567 | Practice locations: Newberg, OR |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D5798 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710097514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14800 SW BULL MOUNTAIN RD",
"city": "TIGARD",
"state": "OR",
"postal_code": "972241233",
"telephone_number": "503-590-1480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 N WASHINGTON ST",
"city": "NEWBERG",
"state": "OR",
"postal_code": "971322727",
"telephone_number": "503-538-2560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDE",
"first_name": "ROBERT",
"middle_name": "CARL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D5798",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newberg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.