Lori S Wilson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401411164 Issued in VA

Practice address

3052 McGehee Rd
Montgomery, AL 36111-2203

Phone

(334) 239-9704

Fax

(334) 239-9505

NPI assigned

Aug 1, 2006

Sex

Female

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 4

Medicare fee-for-service enrollment

Enrolled in AL

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

State licenses

Practice roles

Locations

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.

• Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Montgomery, AL
  • NPI 1205844719
  NPD
• Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Hayneville, AL
  • NPI 1598788218
  NPD
• Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Montgomery, AL
  • NPI 1184284986
  NPD
• Montgomery AIDS Outreach, Inc.

  • Dental Clinic/Center
  • Montgomery, AL
  • NPI 1699316471
  NPD
• West Alabama AIDS Outreach

  • Public Health Dentistry
  • Montgomery, AL
  • NPI 1588378475
  NPD
• Childrens Endodontic Services, PC

  • Endodontics
  • Petersburg, VA
  • NPI 1750403911
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1861409203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 FAIRWAY DR",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363017860",
            "telephone_number": "757-635-0497",
            "fax_number": "804-733-8687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3052 MCGEHEE RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361112203",
            "telephone_number": "334-239-9704",
            "fax_number": "334-239-9505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LORI",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "D-0006715-C",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401411164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9179631",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7996766",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1335151",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "199459",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Burley Wilson
• Karen Anita Wilson
• Kristin Marie Wilson, CRNA
• Lashunda Wilson, LPC
• Latrelle Zorn Wilson, MSC CCC A
• Monet Wilson, DC
• Terrie Lavette Wilson
• Leah Ward Winchester, PHARMD
• Glenn Paul Winkler, LPC
• Stanley B. Winslow, M.D.

• General Practice Dentistry in Montgomery, AL
• Providers in Montgomery, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.