Andrew Robert Wilson, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D1348 Issued in SD

Practice address

700 Sheridan Lake Rd
Rapid City, SD 57702-2407

Phone

(605) 341-3068

Fax

(605) 341-5757

NPI assigned

Jun 8, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Black Hills Pediatric Dentistry

  • Community Health Worker
  • Rapid City, SD
  • NPI 1538889738

  Pediatric Dentistry

  NPD
• Black Hills Pediatric Dentistry

  • Pediatric Dentistry
  • Rapid City, SD
  • NPI 1194867499
  NPD (past)

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1720655772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SHERIDAN LAKE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SHERIDAN LAKE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022407",
            "telephone_number": "605-341-3068",
            "fax_number": "605-341-5757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8200 Dodge St",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "681144113",
            "country_code": "US",
            "telephone_number": "605-484-9421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANDREW",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-08",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "7705",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NE",
            "license": "7705",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SD",
            "license": "D1348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ingrid Williamson
• Marcia Mae Williamson
• Rebecca S Willse, LAC
• Laverne Clarence Willson, LICENSED HEARING INS
• Wilson Anesthesia Services PC
• Diane Wilson, SLP
• Joanna Wilson
• Joleen Wilson, P.T.
• Jonathan Lee Wilson, M.D.
• Joslin Teresa Wilson

• Pediatric Dentistry in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Pediatric Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; 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.