Stephen B Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013704 Issued in GA

Practice address

3515 Dallas Hwy SW Ste B
Marietta, GA 30064-2095

Phone

(678) 684-8157

NPI assigned

Dec 16, 2005

Last updated

May 1, 2012By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335830400000",
    "number": "1891771366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MIDLAND LN",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301574133",
            "telephone_number": "843-540-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 DALLAS HWY SW STE B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300642095",
            "telephone_number": "678-684-8157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "STEPHEN",
        "middle_name": "B",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2012-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "19026680",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "4249",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Wilson, LPC
• Peter J Wilson, D.C.
• Ronald E. Wilson, D.D.S.
• Sara Elizabeth Wilson, AUD
• Skyler Wilson, RBT
• Trina Renee' Wilson, PHD, M.DIV, LCSW
• Jennifer Ann Davis Wimer
• Kevin W Windom, M.D.
• Windy Hill Anesthesia Associates, PC
• Windy Hill Podiatry Associates, P.C.

• General Practice Dentistry in Marietta, GA
• Providers in Marietta, GA by specialty
• General Practice Dentistry in Georgia

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