DR. JACK T WILSON III (NPI# 1396880902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396880902 |
| Entity Type | Individual |
| Full Name | DR. JACK T WILSON III |
| Credential | D.M.D. |
| Practice Address |
12010 Shelbyville Rd Suite 200 Louisville KY 40243-1054 |
| Practice Telephone | 5025834771 |
| Practice Fax Number | 5025849922 |
| Mailing Telephone | 5025834771 |
| Mailing Fax Number | 5025849922 |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
5247 | KY | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | DENTIST - GENERAL PRACTIT | 5247 | 01 |
| Street Address |
12010 SHELBYVILLE RD SUITE 200 |
| City | LOUISVILLE |
| State | KY |
| Zip Code | 40243-1054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609871995 | Francis Beng Kiat Ong | General Practice | 12010 Shelbyville Rd, Suite 500, Louisville, KY 40243-1054 | 2005-06-14 |
| 1902172067 | Suraj K Gathani | Family Medicine | 12010 Shelbyville Rd, Suite 500, Louisville, KY 40243-1054 | 2012-03-22 |
| 1659675403 | Baptist Community Health Services | Emergency Medicine | 12010 Shelbyville Rd, Louisville, KY 40243-1054 | 2011-01-07 |
| 1104018977 | Scott A. Young | Internal Medicine | 12010 Shelbyville Rd, Suite 300, Louisville, KY 40243-1054 | 2007-08-15 |
| 1710179585 | Mark A. Williams | Internal Medicine | 12010 Shelbyville Rd, Suite 300, Louisville, KY 40243-1054 | 2007-08-15 |
| 1861521833 | Middletown Medical Group | Internal Medicine | 12010 Shelbyville Rd, Suite 300, Louisville, KY 40243-1054 | 2007-03-05 |
| 1295898807 | William Bradley King | Emergency Medicine | 12010 Shelbyville Rd, Suite 500, Louisville, KY 40243-1054 | 2006-12-18 |
| 1538256201 | Alexander E Morgan | Emergency Medicine | 12010 Shelbyville Rd, Suite 500, Louisville, KY 40243-1054 | 2006-10-06 |
| 1114935319 | Scott A. Young M.d., Psc | Internal Medicine | 12010 Shelbyville Rd, Suite 300, Louisville, KY 40243-1054 | 2006-08-03 |
| 1821006032 | Mark Williams M.d., LLC | Internal Medicine | 12010 Shelbyville Rd, Suite 300, Louisville, KY 40243-1054 | 2006-08-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942801949 | Pulsemer Health LLC | Clinic/Center | 11408 Shelbyville Rd, Suite 2, Louisville, KY 40243 | 2020-11-05 |
| 1316563372 | Molly Elizabeth Fitzgerald | Counselor | 350 Evergreen Road Suite 102, Louisville, KY 40243 | 2020-06-24 |
| 1215575410 | Eric Wolfe | Pharmacist | 1320 Snake Foot Drive, Apt 204, Louisville, KY 40243 | 2019-12-18 |
| 1417501974 | Joshua Bynum | Physical Therapist | 12935 Shelbyville Road Ste 106, Louisville, KY 40243 | 2019-08-01 |
| 1376013342 | Carmen Sue Frederick | Psychologist | 731 Speckman Road, Louisville, KY 40243 | 2018-12-03 |
| 1205366846 | Triple Crown Dentistry | Dentist | 904 Lily Creek Road, Suite 101, Louisville, KY 40243 | 2017-06-15 |
| 1659811636 | Jean Steltenpohl | Dietitian, Registered | 518 Cheskirk Pl, Louisville, KY 40243 | 2017-02-24 |
| 1548555287 | Jonathan D Senters | Pharmacist | 12975 Shelbyville Road, T-2728, Middletown, KY 40243 | 2011-06-10 |
| 1023339835 | Ashley Rose Havens | Speech-Language Pathologist | 11510 Main Street, Louisville, KY 40243 | 2010-06-15 |
| 1801110424 | Shawna L. Kauffman | Family Medicine | 12955 Shelbyville Rd Ste 2, Louisville, KY 40243 | 2010-03-25 |
| Find all providers in zip 40243 | ||||
| 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 |
|---|---|---|---|---|
| 1235781485 | Rylie Mike-mayer | Dentist | 302 Axis Dr Apt 401, Louisville, KY 40206-0139 | 2019-07-09 |
| 1922580653 | Advanced Dental Center, Inc. | Dentist | 1901 Rudy Ln Ste 4, Louisville, KY 40207-1384 | 2018-08-29 |
| 1043701451 | Diana H Tran | Dentist | 501 S Preston St Rm 148, Louisville, KY 40202-1701 | 2018-05-21 |
| 1992295653 | Tyler Benton Blount | Dentist | 8013 New La Grange Rd Ste 6, Louisville, KY 40222-4700 | 2018-05-17 |
| 1407346901 | Louisville Dental Associates LLC | Dentist | 16701 E Main St, Louisville, MS 39339-2751 | 2018-05-10 |
| 1194238816 | Dental Services of Kentucky, Psc | Dentist | 2011 Grinstead Dr Unit 102, Louisville, KY 40204-1296 | 2017-11-16 |
| 1366963373 | Caleb William Reece | Dentist | 2201 Biljana Dr Apt 1, Louisville, KY 40206-2175 | 2017-06-29 |
| 1205366846 | Triple Crown Dentistry | Dentist | 904 Lily Creek Road, Suite 101, Louisville, KY 40243 | 2017-06-15 |
| 1740733559 | Jonathan Mitchell, Dmd, Psc | Dentist | 1716 Gardiner Ln, Louisville, KY 40205-2738 | 2016-07-27 |
| 1215389168 | Charles Kendrick Bunch | Dentist | 1030 Mulberry St, Louisville, KY 40217-1253 | 2016-07-04 |
| Find all providers in LOUISVILLE | ||||
| City | LOUISVILLE |
| Zip Code | 40243 |
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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.