Richard Allen Wilson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

26065 Issued in TX

Practice address

3828 W Davis St
Suite 310
Conroe, TX 77304-1815

Phone

(936) 756-9015

NPI assigned

Oct 7, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

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.

• Richard a. Wilson, DDS, PA

  • Point of Service
  • Conroe, TX
  • NPI 1326587767
  NPD (past) Authorized official

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487203200000",
    "number": "1760633929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3828 W DAVIS ST",
            "address_2": "SUITE 310",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773041815",
            "telephone_number": "936-756-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3828 W DAVIS ST",
            "address_2": "SUITE 310",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773041815",
            "telephone_number": "936-756-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RICHARD",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-07",
        "last_updated": "2017-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "26065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST-GENERAL PRACTICE",
            "identifier": "1223G0001X",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1223G0001X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Wilson, OTR
• Kristie Wilson
• Maurice Joe Wilson, O.D.
• Michel R Wilson, LPC
• Nicole Wilson, DIRECTOR
• Sandra Dee Wilson
• Savannah Wilson
• Stephanie Ivy Wilson
• Rita Wiltz, CHWI, CHW
• Kenneth L Winaker, M.D.

• General Practice Dentistry in Conroe, TX
• Providers in Conroe, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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.