Garrett Lee Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40869 Issued in TX

Practice address

1606 W McClain Ave
Scottsburg, IN 47170-1161

Phone

(812) 414-4100

NPI assigned

Jan 24, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

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

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1780390807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 CLEO AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402132342",
            "telephone_number": "502-602-3748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1606 W MCCLAIN AVE",
            "city": "SCOTTSBURG",
            "state": "IN",
            "postal_code": "471701161",
            "telephone_number": "812-414-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "638 Uptown Blvd",
            "address_purpose": "LOCATION",
            "city": "Cedar Hill",
            "state": "TX",
            "postal_code": "751043538",
            "country_code": "US",
            "telephone_number": "972-299-9666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GARRETT",
        "middle_name": "LEE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-24",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12014107A",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "40869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wellness Chiropractic Center, P.S.C. (Scott County Chiropractic)
• Evan West, PHARMD
• Ronald Lynn West, R.PH
• Lisa Whittaker, LCSW
• Elijah Shay Wilkin, PHARMD
• Randol Olen Woolbright Jr., D.D.S.
• David Yeager
• Noreen Elaine Young, MS, RD, LD
• Debra Marie Zimmer, FNP-C
• Brenda Joyce Zollman, RN

• General Practice Dentistry in Scottsburg, IN
• Providers in Scottsburg, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2024; 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.