Kelly Brooks Wilson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8162 Issued in NC

Practice address

2201 S Blvd
Suite 210
Charlotte, NC 28203-6208

Phone

(704) 333-4760

NPI assigned

Feb 8, 2007

Sex

Female

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 NC

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southview Dentistry

  • Dentist
  • Charlotte, NC
  • NPI 1962634816

  General Practice

  NPD (past)

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351728000000",
    "number": "1841330768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 TEXTILE WAY",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282051265",
            "telephone_number": "704-564-3285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 S BLVD",
            "address_2": "SUITE 210",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282036208",
            "telephone_number": "704-333-4760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLY",
        "middle_name": "BROOKS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2012-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "8162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan David Wilson, MD
• Kasey J. Wilson, M.ED.
• Katherine Lee Wilson, MS
• Katherine Lynn Wilson, PA-C
• Keisha Chalet Wilson, HAIR LOSS SPECIALIST
• Kelly Comolli Wilson, MD
• Kelsi Wilson, LMFT
• Kennedy Grace Wilson
• Kimberly Lannette Wilson, LMFT
• Lamar Wilson

• General Practice Dentistry in Charlotte, NC
• Providers in Charlotte, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2012; 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.