Fred H Wilson III, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14592 Issued in TX

Practice address

1395 Sattler Rd Ste 4
Canyon Lake, TX 78132-2296

Phone

(830) 964-3161

Fax

(830) 226-5019

NPI assigned

Jan 16, 2007

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 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

State licenses

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811049570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2225",
            "address_2": "1395 SATTLER RD #4",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781330009",
            "telephone_number": "830-964-3161",
            "fax_number": "830-226-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 SATTLER RD STE 4",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781322296",
            "telephone_number": "830-964-3161",
            "fax_number": "830-226-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "FRED",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "14592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Ann Trainer
• Charles Gordon Tubbs, M.D.
• Jannah Holley Vise, L. AC
• Wempower USA
• Virginia R White, LVN
• Celeste Windham, RDN
• Windmill Wellness Ranch LLC
• Kimberley Dawn Wood, LPC
• Christopher Zimmerman

• General Practice Dentistry in Canyon Lake, TX
• Providers in Canyon Lake, 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 Jul 8, 2007; 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.