Active NPI
Shawn Kevin Wilson, DDS
- General Practice Dentistry
- Redding, CA
National Provider Identifier
1811337553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 032518
- Practice address
- 3110 Churn Creek Rd
Redding, CA 96002 - Phone
- (530) 222-0515
- Fax
- (530) 222-1623
- NPI assigned
- Jun 26, 2013
- Sex
- Male
- Sole proprietor
- Yes
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 | 032518 | CA | Primary |
Addresses
Primary practice location
3110 Churn Creek Rd
Redding, CA 96002
Mailing address
3110 Churn Creek Rd
Redding, CA 96002
Phone (530) 222-0515
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811337553 | Other | CA | INDIVIDUAL NPI |
| 1477636280 | Other | CA | CORPORATE NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032518 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412208000000",
"number": "1811337553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3110 CHURN CREEK RD",
"city": "REDDING",
"state": "CA",
"postal_code": "96002",
"telephone_number": "530-222-0515",
"fax_number": "530-222-1623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3110 CHURN CREEK RD",
"city": "REDDING",
"state": "CA",
"postal_code": "96002",
"telephone_number": "530-222-0515",
"fax_number": "530-222-1623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHAWN",
"middle_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-26",
"last_updated": "2014-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "032518",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL NPI",
"identifier": "1811337553",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CORPORATE NPI",
"identifier": "1477636280",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.