C Thomas Wilson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1235G Issued in WI

Practice address

703 S Bay Shore Dr
Suite #4
Sister Bay, WI 54234

Phone

(920) 854-5200

Fax

(920) 854-7601

NPI assigned

May 9, 2007

Last updated

Jul 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Northern Door Dental SC

  • General Practice Dentistry
  • Sister Bay, WI
  • NPI 1013038207
  NPD (past)

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216944000000",
    "number": "1841404969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10589 S HIGHLAND RD",
            "address_2": "STE 4",
            "city": "SISTER BAY",
            "state": "WI",
            "postal_code": "54234",
            "telephone_number": "920-854-5200",
            "fax_number": "920-854-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 S BAY SHORE DR",
            "address_2": "SUITE #4",
            "city": "SISTER BAY",
            "state": "WI",
            "postal_code": "54234",
            "telephone_number": "920-854-5200",
            "fax_number": "920-854-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "C",
        "middle_name": "THOMAS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-09",
        "last_updated": "2008-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1235G",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33495100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James R Thomas, R.PH
• Paige Catherine Thompson
• Timothy D. Tishler, D.D.S.
• Deborah Marie Webber, DC
• Alison Werner, L.AC.

• General Practice Dentistry in Sister Bay, WI
• Providers in Sister Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.