Kelley Stewart Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7960 Issued in OR

Practice address

5025 SE 28TH Ave
Portland, OR 97202-4445

Phone

(503) 238-4418

Fax

(503) 238-0360

NPI assigned

Jul 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kelley Yvonne Stewart Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Kaiser Dental

  • Dental Assistant
  • Portland, OR
  • NPI 1003965922
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315353600000",
    "number": "1942224332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19075 NW TANASBOURNE DR. #300",
            "address_2": "SUNSET DENTAL OFFICE",
            "city": "HILLBORO",
            "state": "OR",
            "postal_code": "97124",
            "telephone_number": "503-531-1700",
            "fax_number": "503-531-1704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5025 SE 28TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972024445",
            "telephone_number": "503-238-4418",
            "fax_number": "503-238-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLEY",
        "middle_name": "STEWART",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2011-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7960",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "STEWART",
            "middle_name": "YVONNE",
            "credential": "DMD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jonathan Wilson
• Jonathan Wyatt Wilson
• Joscelyn R. Wilson, M.A.
• Kaitlyn Wilson
• Karole H Wilson, D.M.D., PC
• Kristen Massing Wilson, PHARM.D.
• Kyla Wilson
• Leah M Wilson, M.D.
• Leilani Lesta Wilson
• Lisa Ann M Wilson, RPH

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2011; 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.