Stephen Wilson, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

30.018004 Issued in OH

Practice address

380 Butterfly Gardens Dr
Columbus, OH 43215-7508

Phone

(614) 722-5650

NPI assigned

May 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1821042797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 CHILDRENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432052664",
            "telephone_number": "614-722-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 BUTTERFLY GARDENS DR",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432157508",
            "telephone_number": "614-722-5650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 Childrens Dr",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432052664",
            "country_code": "US",
            "telephone_number": "614-722-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "STEPHEN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.018004",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OH",
            "license": "30.018004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0622302",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shantina Wilson
• Shari Rae Wilson, CNP
• Sharia L Wilson, EMT-B
• Sharnetta Wilson
• Sheria Diane Wilson, M.D.
• Susan Kay Wilson, D.D.S.
• Sydney Wilson
• Tacoma Distance Wilson
• Takai Marie Wilson
• Talaysia Lovette Wilson, CDCA

• Pediatric Dentistry in Columbus, OH
• Providers in Columbus, OH by specialty
• Pediatric Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.