NPIMap

Organization Active NPI

Wiley Pediatric Dentistry, LLC

  • Pediatric Dentistry
  • Indianapolis, IN
National Provider Identifier
1902457039
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
WILEY PEDIATRIC DENTISTRY, LLC
Doing business as
Speedway Pediatric Dentistry
Practice address
6211 W 30TH St Ste D
Indianapolis, IN 46224-3057
Phone
(317) 299-0353
NPI assigned
Sep 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Dr. Dillon T Wiley, DDS, MSDNPI 1790213098
Title
Dentist / Owner
Phone
(317) 695-3604

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
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

6211 W 30TH St Ste D
Indianapolis, IN 46224-3057

Mailing address

6211 W 30TH St Ste D
Indianapolis, IN 46224-3057
Phone (317) 299-0353

Other identifiers 6

IdentifierTypeStateIssuer
12012708AOtherININ DENTAL LICENSE
300003242MedicaidIN
1629161518OtherINNPI TYPE 1
12009076AOtherININ DENTAL LICENSE
1790213098OtherINNPI TYPE 1
300015869MedicaidIN

Other names 1

  • Speedway Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

6211 W 30th St
Ste D
Indianapolis, IN 46224
Phone (317) 299-0353

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": "1568937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1902457039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6211 W 30TH ST STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462243057",
            "telephone_number": "317-299-0353",
            "fax_number": "317-298-8196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6211 W 30TH ST STE D",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462243057",
            "telephone_number": "317-299-0353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILEY PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-20",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "DILLON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "DENTIST / OWNER",
        "authorized_official_telephone_number": "317-695-3604",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MSD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN DENTAL LICENSE",
            "identifier": "12012708A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300003242",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1629161518",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IN DENTAL LICENSE",
            "identifier": "12009076A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1790213098",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300015869",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Speedway Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; 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.