Active NPI
Glenn Dean Wilson, DDS
- General Practice Dentistry
- Chattanooga, TN
National Provider Identifier
1730230111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 8395
- Practice address
- 4601 Brainerd Rd
Chattanooga, TN 37411-3826 - Phone
- (423) 698-6005
- NPI assigned
- Jan 14, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 8395 | TN | Primary |
Addresses
Primary practice location
4601 Brainerd Rd
Chattanooga, TN 37411-3826
Mailing address
4601 Brainerd Rd
Chattanooga, TN 37411-3826
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20160205000642 | TN | Order and Referring Only - Other (Non-Physician) | 1456655885 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8395 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453248000000",
"number": "1730230111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 BRAINERD RD",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374113826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 BRAINERD RD",
"city": "CHATTANOOGA",
"state": "TN",
"postal_code": "374113826",
"telephone_number": "423-698-6005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "GLENN",
"middle_name": "DEAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-14",
"last_updated": "2016-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "8395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chattanooga, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2016; 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.