Freddie Earl Wilkes Jr., D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

4346-22 Issued in MS

Practice address

2154 Goodman Rd W # 1
Horn Lake, MS 38637-1303

Phone

(662) 392-9200

NPI assigned

Jul 31, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

State licenses

Practice roles

Locations

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.

• Keep on Smiling Pediatric and General Dentistry PLLC

  • Dentist
  • Southaven, MS
  • NPI 1104511823
  NPD

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1972859627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3451 GOODMAN RD E STE 122",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729302",
            "telephone_number": "662-892-8565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2154 GOODMAN RD W # 1",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371303",
            "telephone_number": "662-392-9200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3451 Goodman Rd E Ste 122",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386729302",
            "country_code": "US",
            "telephone_number": "662-892-8565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKES",
        "first_name": "FREDDIE",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-31",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "RES.3249",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "4346-22",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Kenora S Wallace
• Sarah Walls
• Kayla Washington, M.ED
• Stephanie White, FNP-C
• William E Middleton Jr DDS PA
• Ladarrius Tremell Williams
• Wilson'S Sensational Care, LLC
• Kyna Robinson Woollery, MS
• Mary C Worlds

• All providers in Horn Lake, MS
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.