NPIMap

Organization Active NPI

Paul R Wild DDS PA

  • General Practice Dentistry
  • Mendota Heights, MN
National Provider Identifier
1871155788
Registry record updated Nov 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PAUL R WILD DDS PA
Practice address
750 Main St
Suite 215
Mendota Heights, MN 55118
Phone
(651) 452-0261
Fax
(651) 452-6109
NPI assigned
Jul 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2019

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

Authorized official

Name
Dr. Paul William Wild, DDSNPI 1225145501
Title
Owner
Phone
(651) 452-0261

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

750 Main St
Suite 215
Mendota Heights, MN 55118

Mailing address

750 Main St
Suite 215
Mendota Heights, MN 55118
Phone (651) 452-0261

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573084800000",
    "number": "1871155788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 MAIN ST",
            "address_2": "SUITE 215",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "55118",
            "telephone_number": "651-452-0261",
            "fax_number": "651-452-6109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MAIN ST",
            "address_2": "SUITE 215",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "55118",
            "telephone_number": "651-452-0261",
            "fax_number": "651-452-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL R WILD DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-01",
        "last_updated": "2019-11-07",
        "status": "A",
        "authorized_official_last_name": "WILD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-452-0261",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mendota Heights, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; 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.