DR. WYATT WILLIAM WILSON DMD NPI 1023423639

NPI Information

NPI: 1023423639
Provider Name: DR. WYATT WILLIAM WILSON, DMD
Classification: Dentist - 1223G0001X
Entity Type: Individual

Specialization: General Practice

PECOS Registration: Yes

Address:
19029 BEAVERCREEK RD
OREGON CITY, OR
ZIP 97045
Phone: (503) 941-3064
Get Directions

DR. Wyatt William Wilson, DMD is a general practice dentist in Oregon City, OR. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Wyatt William Wilson, DMD NPI is 1023423639. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

19029 BEAVERCREEK RD
OREGON CITY, OR
ZIP 97045-537
Phone: (503) 941-3064
Fax: (503) 941-3075

The NPI 1023423639 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 6/23/2014 and was last updated on 4/20/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223G0001X	Dentist	General Practice	D10058	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	500675716	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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