Dr. Bruce T. Wilson D.D.S., PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

DR. BRUCE T. WILSON D.D.S., PA

Doing business as

Wilson Dental

Practice address

3455 W State Highway 18
Manila, AR 72442-8005

Phone

(870) 561-4400

Fax

(870) 561-4037

NPI assigned

Jan 7, 2021

Last updated

Jan 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tanya McCain

Title

Office Manager

Phone

(870) 561-4400

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wilson Dental Doing business as

Electronic endpoints 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bruce T Wilson, D.D.S.

  • General Practice Dentistry
  • Manila, AR
  • NPI 1962561290
  NPD
• Jeffrey Alex Rowlan, DDS

  • General Practice Dentistry
  • Jonesboro, AR
  • NPI 1962177485
  NPD (past)

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609977600000",
    "number": "1821686684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1345",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724421345",
            "telephone_number": "870-561-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3455 W STATE HIGHWAY 18",
            "city": "MANILA",
            "state": "AR",
            "postal_code": "724428005",
            "telephone_number": "870-561-4400",
            "fax_number": "870-561-4037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. BRUCE T. WILSON D.D.S., PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-07",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A",
        "authorized_official_last_name": "MCCAIN",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-561-4400"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180606608",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Manila",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3455 W State Highway 18",
            "city": "Manila",
            "state": "AR",
            "country_code": "US",
            "postal_code": "724428005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wilson Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Delta Behavioral Health, LLC
• Delta Drugs Inc (Delta Drug Inc)
• Kylie Meghan Devries, LMSW
• Skiver Lynn Dilldine
• Heather Michelle Dobbins
• Elite Senior Care LLC
• Elite Senior Care Management Company LLC
• Nakisha Nicole Fuentes
• Victoria L Gamble, APN
• Angela Gipson, LAC

• Dental Clinic/Center in Manila, AR
• Providers in Manila, AR by specialty
• Dental Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.