Kelly Jay Wilson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

52954 Issued in CA

Practice address

5800 Stanford Ranch Rd
BLDG #900
Rocklin, CA 95765-4385

Phone

(916) 663-5555

NPI assigned

Mar 1, 2007

Last updated

Jul 8, 2007By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• James Robison, DMD, Inc

  dba Rocklin Dental

  • Dental Clinic/Center
  • Rocklin, CA
  • NPI 1649945155
  NPD (past)

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942338819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5022 BRADFORD DR",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957655323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 STANFORD RANCH RD",
            "address_2": "BLDG #900",
            "city": "ROCKLIN",
            "state": "CA",
            "postal_code": "957654385",
            "telephone_number": "916-663-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELLY",
        "middle_name": "JAY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "52954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Elaine Williams, D.C.
• Jordyn Willis
• Rosanne Willis
• Aretha Wilson
• Deborah Marie Wilson, CMT
• Madison Wilson, CMT
• Rachel Wilson
• Khaing Khaing Win, MD
• Wishing U Well Medical Inc
• Sue Ann Wissler, PAC

• General Practice Dentistry in Rocklin, CA
• Providers in Rocklin, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.