JACK W. WILSON (NPI# 1598774465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598774465 |
| Entity Type | Individual |
| Full Name | JACK W. WILSON |
| Credential | DDS |
| Practice Address |
534 Luzerne St Mount Ida AR 71957-9449 |
| Mailing Address |
1201 Mena St Mena AR 71953-4280 |
| Practice Telephone | 8708674244 |
| Practice Fax Number | 8708674254 |
| Mailing Telephone | 4793942332 |
| Mailing Fax Number | 4794373708 |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2008-04-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
5303 | OK | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | BLUE CROSS BLUE SHIELD | 450463188002 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114241239 | Jack H Wilson | Counselor | 11730 Highway 9 West, Stigler, OK 74462 | 2010-03-18 |
| 1821122102 | Jack A. Wilson | Dentist | 2200 Interstate 20 W Ste 200, Arlington, TX 76017-1649 | 2007-03-16 |
| 1396806519 | Jack Wilson | Pharmacist | 8823 Avenue L, Brooklyn, NY 11236-4781 | 2006-12-12 |
| 1790756542 | Jack Edward Wilson | Surgery | 3 Walnut St Ste 100, Lemoyne, PA 17043 | 2006-01-30 |
| 1518941517 | Jack Cook Wilson | Family Medicine | 612 E 9th St, Mountain Home, AR 72653-4804 | 2005-12-02 |
| 1356349559 | Jack Kenney Wilson Jr. | Internal Medicine | 637 S Kerr Ave, Wilmington, NC 28403-8423 | 2005-07-12 |
| 1043216807 | Jack Anthony Wilson | Dental Hygienist | 2654 Stacey Way, National City, CA 91950-7760 | 2005-06-24 |
| 1497949929 | Jack L Wilson | Dentist | 1721 S Cleveland Ave, Suite 100, Sioux Falls, SD 57103-5501 | 2007-08-28 |
| 1316002314 | Jack Wilson | Dentist | 12320 N 32nd St, Suite 1, Phoenix, AZ 85032-7154 | 2006-12-27 |
| 1033125299 | Jack M Wilson | Emergency Medicine | 6655 Alvarado Rd, San Diego, CA 92120-5208 | 2006-07-31 |
| Street Address |
534 LUZERNE ST |
| City | MOUNT IDA |
| State | AR |
| Zip Code | 71957-9449 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841276003 | Jimmy L Barrow | Family Medicine | 534 Luzerne St, Mount Ida, AR 71957 | 2005-12-20 |
| 1689166886 | Schasta Lyn Hibbs | Nurse Practitioner | 534 Luzerne St, Mount Ida, AR 71957 | 2018-06-04 |
| 1992224950 | Amy Stvartak | Nurse Practitioner | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2017-09-11 |
| 1952727000 | Julie Kay Williams | Nurse Practitioner | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2014-03-13 |
| 1164730867 | Stephanie Leona Matthews | Social Worker | 534 Luzerne St, Mount Ida, AR 71957 | 2010-09-16 |
| 1275795056 | Healthy Connections Inc | Dentist | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2008-07-02 |
| 1265627616 | Healthy Connections, Inc | Clinic/Center | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2007-09-10 |
| 1194780429 | Thomas Edward Baldwin | Family Medicine | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2006-04-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619326881 | Wagner Drugs, Inc. | Pharmacy | 744 Hwy 270 East, Mount Ida, AR 71957 | 2016-06-08 |
| 1245699636 | Seeking Serenity Holistic Therapy Center | Social Worker | 506 Hwy 270 E, Mt.ida, AR 71957 | 2016-02-15 |
| 1518368562 | Village Apothecary, Inc. | Durable Medical Equipment & Medical Supplies | 136 S George Street, Mt Ida, AR 71957 | 2014-09-09 |
| 1306276217 | Compleat Rehab and Sports Therapy Center(satellite Branch)of Jordan Pt | Physical Therapist | 135 South East Street, Mt.ida, AR 71957 | 2013-11-14 |
| 1265871370 | Barbara E Page | Veterinarian | 317 North George St, Mount Ida, AR 71957 | 2013-06-21 |
| 1609079102 | Cynthia Jean Crowson | Social Worker | 506 Highway 270 East, Mt. Ida, AR 71957 | 2007-06-11 |
| 1124229794 | David P Hochstedler | Physical Therapist | 741 South Dr, Mt. Ida, AR 71957 | 2007-05-30 |
| 1386864791 | Samantha Dawn Ashford | Physical Therapy Assistant | 741 S Drive, Mount Ida, AR 71957 | 2007-04-26 |
| 1396964557 | Jerry Daniel Mullin | Skilled Nursing Facility | 741 South Drive, Mt. Ida, AR 71957 | 2007-04-25 |
| 1861585002 | City Drug and Soda Fountain | Durable Medical Equipment & Medical Supplies | 121 W S West Street, Mount Ida, AR 71957 | 2006-10-02 |
| Find all providers in zip 71957 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568525731 | Ronnie Lee Faulkner | Dentist | 138 Hwy 270 East, Mount Ida, AR 71957-0901 | 2006-12-19 |
| 1275795056 | Healthy Connections Inc | Dentist | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2008-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043826944 | Atlas Dental Partners Pllc | Dentist | 3903 W Financial Pkwy, Rogers, AR 72758-1471 | 2020-09-17 |
| 1669086724 | Epic Smiles Pllc | Dentist | 310 E Centerton Blvd, Centerton, AR 72719 | 2020-09-04 |
| 1063023554 | Christopher Marshall | Dentist | 1804 Old Greensboro Rd Bldg B, Jonesboro, AR 72405-0003 | 2020-08-10 |
| 1790394393 | Robert W Bassham Dds Pa | Dentist | 669 Addison Dr, Wynne, AR 72396-1602 | 2020-07-29 |
| 1215545710 | Justin Michael Cooper | Dentist | 5008 S U St Ste 101a, Fort Smith, AR 72903-3613 | 2020-07-21 |
| 1740898584 | Jamie Beavers Dds, P.a. | Dentist | 354 Main Street, Clinton, AR 72031 | 2020-07-17 |
| 1144848490 | Abbey Lynn Norwood | Dentist | 5501 W Pinnacle Pointe Dr Ste 1, Rogers, AR 72758-8133 | 2020-07-13 |
| 1093332728 | Michael Drake | Dentist | 9601 Baptist Health Dr Ste 104, Little Rock, AR 72205-6323 | 2020-06-29 |
| 1235753682 | Drew Bannerman Dds, P.a. | Dentist | 4603 Fairway Ave, North Little Rock, AR 72116-8052 | 2020-06-02 |
| 1669021564 | Steven Michael Clark | Dentist | 1700 University Blvd Ste 105, Morrilton, AR 72110-8004 | 2019-09-04 |
| Find all providers with the same taxonomy | ||||
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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.