DR. KEITH JONATHAN WILSON (NPI# 1578621769) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578621769 |
| Entity Type | Individual |
| Full Name | DR. KEITH JONATHAN WILSON |
| Credential | DDS |
| Practice Address |
10590 Enduring Freedom Dr Us Army Dental Activity Fort Drum NY 13602-5005 |
| Practice Telephone | 3157726234 |
| Mailing Telephone | 3157726234 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2016-06-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 0401008681 | VA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982949988 | Keith L Wilson IIi | Counselor | 1330 E Cherry St # 12, Springfield, MO 65802-3429 | 2012-12-01 |
| 1467604744 | Keith C Wilson | Specialist/Technologist, Other | 2503 Robin Knoll Ct, Fresno, TX 77545-8167 | 2008-10-16 |
| 1609022219 | Keith Raymond Wilson | Counselor | 1596 Monroe Ave, Rochester, NY 14618-1415 | 2008-08-14 |
| 1346391976 | Keith Peter Wilson | Dentist | 211 N Second St, Po 727, Peotone, IL 60468-8837 | 2007-01-12 |
| 1205907615 | Keith Wilson | Chiropractor | 1717 Amwell Road, Somerset, NJ 08873 | 2006-11-10 |
| 1609307560 | Keith Wilson | Counselor | 8915 Sw Center St, Tigard, OR 97223-6307 | 2017-03-22 |
| 1851732697 | Keith Wilson | Prosthetic/Orthotic Supplier | 1823 Charlotte Ave, Nashville, TN 37203-2104 | 2013-07-09 |
| 1255776258 | Keith Garnett Wilson | Emergency Medicine | 155 N Fresno St, Fresno, CA 93701 | 2013-05-03 |
| 1720248198 | Keith D Wilson Jr. | General Practice | 11722 Reisterstown Rd, Reisterstown, MD 21136-3302 | 2008-06-10 |
| 1841470507 | Keith Alan Wilson | Physician Assistant | 12550 Hesperia Road, Suite100, Victorville, CA 92395-0000 | 2007-11-11 |
| Street Address |
10590 ENDURING FREEDOM DR US ARMY DENTAL ACTIVITY |
| City | FORT DRUM |
| State | NY |
| Zip Code | 13602-5005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669087771 | Mitchell Garrett Lamb | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2020-09-15 |
| 1356955603 | Euris Miguel Mieses | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2020-09-03 |
| 1003464009 | Jacob Miller Allen | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2019-09-03 |
| 1568957694 | Sarah Marie Mcsherry | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2018-07-01 |
| 1134614563 | Jacob D Woodward | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2018-06-27 |
| 1821500802 | Bianca Garcia | Dental Hygienist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5005 | 2017-10-30 |
| 1265976328 | Hye H Kim | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5005 | 2016-12-08 |
| 1467803338 | Dennis Nicholson | Dental Assistant | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5005 | 2016-06-22 |
| 1841649530 | Julie Wainwright | Dental Assistant | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5005 | 2016-06-03 |
| 1669821351 | Jonathan Smith | Dental Assistant | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5005 | 2016-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235697590 | Joshua Lee Hickman | Physician Assistant | Bldg P10506 Euphrates River Valley Rd, Fort Drum, NY 13602 | 2019-03-06 |
| 1447721345 | Lisa Marie Lewis | Social Worker | 11044 Mount Belvedere Blvd, Fort Drum, NY 13602 | 2018-12-17 |
| 1720555253 | Elizabeth M Hover | Social Worker | P11050 Mt Belvedere Blvd, Fort Drum, NY 13602 | 2018-11-02 |
| 1376037424 | Phillip Dakotah Mitchell | Physician Assistant | 10020 Euphrates River Valley Road, Fort Drum, NY 13602 | 2018-06-20 |
| 1063902666 | Guthrie Ahc | Clinic/Center | P19914 M3r Tampa, Fort Drum, NY 13602 | 2018-05-18 |
| 1255846879 | Morgan Elizabeth Callari | Dental Hygienist | 10205 S Riva Ridge Loop, Fort Drum, NY 13602 | 2017-12-05 |
| 1609389097 | John Charles Bockmann | Physician Assistant | Connor Troop Medical Clinic, 10506 Euphrates River Valley Rd, Fort Drum, NY 13602 | 2017-11-08 |
| 1902318207 | Nicholas Andrew Jones | Military Health Care Provider | 10506 S. Riva Ridge, Fort Drum, NY 13602 | 2017-10-26 |
| 1508389198 | Richard Scott Christiansen | Physical Therapist | 10330 S Riva Ridge Loop, Fort Drum, NY 13602 | 2017-07-25 |
| 1811418098 | Emer B Bajuelos | Dentist | Ft Drum W07uaa 10590, Ft Drum, Apo, AP 13602 | 2017-06-28 |
| Find all providers in zip 13602 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801307012 | Caryn Shermetaro | Dentist | 10012 S Riva Ridge Loop, Fort Drum, NY 13602-5492 | 2017-10-14 |
| 1669087771 | Mitchell Garrett Lamb | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2020-09-15 |
| 1356955603 | Euris Miguel Mieses | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2020-09-03 |
| 1003464009 | Jacob Miller Allen | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2019-09-03 |
| 1568957694 | Sarah Marie Mcsherry | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5503 | 2018-07-01 |
| 1366967663 | Kaleigh Marie Namiotka | Dentist | 10590 Enduring Freedom Drive, Fort Drum, NY 13602 | 2017-08-08 |
| 1265976328 | Hye H Kim | Dentist | 10590 Enduring Freedom Dr, Fort Drum, NY 13602-5005 | 2016-12-08 |
| 1922552116 | Taylor Thomas Mason | Dentist | 10205 N Riva Ridge Loop, Fort Drum, NY 13602-5457 | 2016-08-05 |
| 1558711010 | Tylen K Haderlie | Dentist | 10205 N Riva Ridge Loop, Fort Drum, NY 13602-5457 | 2016-06-15 |
| 1497152409 | Spencer Joseph | Dentist | 10590 Enduring Freedom Drive, Fort Drum, NY 13602 | 2014-11-20 |
| Find all providers in FORT DRUM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.