Active NPI
Irvin Larry Wilder, DDS
- Dentist
- Randallstown, MD
National Provider Identifier
1902008865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5877
- Practice address
- 9015 #1 Liberty Rd.
Randallstown, MD 21133 - Phone
- (410) 922-6800
- Fax
- (410) 922-6801
- NPI assigned
- Jun 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5877 | MD | Primary |
Addresses
Primary practice location
9015 #1 Liberty Rd.
Randallstown, MD 21133
Mailing address
9015 #1 Liberty Rd.
Randallstown, MD 21133
Phone (410) 922-6800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5877 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571184000000",
"number": "1902008865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9015 #1 LIBERTY RD.",
"city": "RANDALLSTOWN",
"state": "MD",
"postal_code": "21133",
"telephone_number": "410-922-6800",
"fax_number": "410-922-6801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9015 #1 LIBERTY RD.",
"city": "RANDALLSTOWN",
"state": "MD",
"postal_code": "21133",
"telephone_number": "410-922-6800",
"fax_number": "410-922-6801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "IRVIN",
"middle_name": "LARRY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-04",
"last_updated": "2019-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "5877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Randallstown, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.