Deidre Smith Wilson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401415246 Issued in VA

Practice address

195 E Spring St
Wytheville, VA 24382-2659

Phone

(276) 228-8571

Fax

(276) 228-8571

NPI assigned

Jun 13, 2016

Last updated

Sep 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Deidre Mechele Smith Former name

Medicare fee-for-service enrollment

Enrolled in VA

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wilson Dental PC

  • General Practice Dentistry
  • Wytheville, VA
  • NPI 1487155867
  NPD

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

{
    "created_epoch": "1465776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1891144622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 COMMUNITY BLVD",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "24382",
            "telephone_number": "276-228-8571",
            "fax_number": "276-228-8571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "195 E SPRING ST",
            "city": "WYTHEVILLE",
            "state": "VA",
            "postal_code": "243822659",
            "telephone_number": "276-228-8571",
            "fax_number": "276-228-8571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEIDRE",
        "middle_name": "SMITH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-13",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401415246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEIDRE",
            "last_name": "SMITH",
            "middle_name": "MECHELE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Nicole Whitt, COTA
• Andrew Preston Widener, FNP
• Mary K Willard, LICENSED PHYSICAL TH
• Megan L Williams, RD
• Wilson Dental PC
• Eric Wilson, D.D.S.
• Matthew Woodlee, LMT
• Taylor Woodlief, FNP-BC
• Amanda Stoots Wright, FNP-C
• Kelly Miller Wyrick

• Dentist in Wytheville, VA
• Providers in Wytheville, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.