Active NPI
John D Wildgen, DDSPC
- General Practice Dentistry
- Laurie, MO
National Provider Identifier
1922282995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 013788
- Practice address
- 128 South Main Street
Laurie, MO 65038 - Phone
- (573) 374-5739
- Fax
- (573) 374-8901
- NPI assigned
- Dec 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 013788 | MO | Primary |
Addresses
Primary practice location
128 South Main Street
Laurie, MO 65038
Mailing address
128 South Main Street
P.O. Box 1083
Laurie, MO 65038
Phone (573) 374-5739
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John D Wildgen DDS PC | General Practice | Past | Accepting new patients |
| Dental Professionals of Missouri, Richard Straus, D.M.D., P.C. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Gravois Mills, MO
- NPI 1558966796
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198627200000",
"number": "1922282995",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "128 SOUTH MAIN STREET",
"address_2": "P.O. BOX 1083",
"city": "LAURIE",
"state": "MO",
"postal_code": "65038",
"telephone_number": "573-374-5739",
"fax_number": "573-374-8901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "128 SOUTH MAIN STREET",
"city": "LAURIE",
"state": "MO",
"postal_code": "65038",
"telephone_number": "573-374-5739",
"fax_number": "573-374-8901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDGEN",
"first_name": "JOHN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DDSPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-12-26",
"last_updated": "2007-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "013788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurie, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.