Ryan H Wilson DDS LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DD3162 Issued in NM

Legal business name

RYAN H WILSON DDS LLC

Doing business as

Canyon Dental Care

Practice address

4760 N Butler Ave Ste D
Farmington, NM 87401-0816

Phone

(505) 278-7007

Fax

(505) 325-0817

NPI assigned

Oct 10, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Ryan Hastiin Wilson, D.D.S.

Title

President/Owner Dentist

Phone

(505) 278-7007

Specialties & licenses 1

Addresses

Other names 1

• Canyon Dental Care Doing business as

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

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412899200000",
    "number": "1942604533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4760 N BUTLER AVE STE D",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874010816",
            "telephone_number": "505-278-7007",
            "fax_number": "505-325-0817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 N BUTLER AVE STE D",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874010816",
            "telephone_number": "505-278-7007",
            "fax_number": "505-325-0817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RYAN H WILSON DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2014-10-10",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "HASTIIN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER DENTIST",
        "authorized_official_telephone_number": "505-278-7007",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elysia Russell, LCSW
• Gordon D. Russell, O.D.
• Lacy Russell, WHNP-BC
• Virginia Russell
• Michael Joseph Rutledge, M.D.
• Quincy Sa'Ena, DO
• Daniel John Sabol, DO
• Ariadna Sadziene-Bessinger, M.D.
• Manuel Saenz
• Safeway Inc (Safeway Pharmacy #2004)

• Dentist in Farmington, NM
• Providers in Farmington, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; 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.