Brian L Wilson, D.M.D.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

D7843 Issued in OR

Practice address

2350 NW Century Dr
Ste #200
Corvallis, OR 97330-3495

Phone

(541) 768-0419

Fax

(541) 768-0521

NPI assigned

Jul 11, 2005

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

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Valley Endodontics

  • Endodontics
  • Corvallis, OR
  • NPI 1760997803
  NPD (past) Authorized official

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390521600000",
    "number": "1740288034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 NW CENTURY DR",
            "address_2": "STE #200",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303495",
            "telephone_number": "541-768-0419",
            "fax_number": "541-768-0521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 NW CENTURY DR",
            "address_2": "STE #200",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973303495",
            "telephone_number": "541-768-0419",
            "fax_number": "541-768-0521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRIAN",
        "middle_name": "L",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2014-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OR",
            "license": "D7843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Maria Williamson, PHARM.D.
• Spencer Williamson
• Tanner Williford, DO
• Katherine Brooke Willis, L.AC, MAOM
• Angie Wilson
• Brian S Wilson, D.P.T.
• Ethan B. Wilson, M.D.
• Paula Wilson
• Tammy Jo Wilson
• Carolyn Marie Wiltbank, MA

• Endodontics in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Endodontics in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.

Verify at the official NPI Registry.