Jarell Wilson, DDS

Public-record details

Address

103 Medicine Way Rd, Peridot, AZ 85542

Phone

(928) 475-1495

Listed under

Individual pediatric dentists

NPI

1336694116

NPI status

Active in the NPPES registry

Provider type

Individual provider

Registered specialty (self-reported taxonomy)

Pediatric Dentistry (1223P0221X)

Credentials listed

DDS

License number on NPI record

D010564 (AZ)

NPI first issued

Aug 22, 2016

Years since NPI first issued

10 years (since 2016)

License state on NPI record

AZ

NPI record last updated

Jun 12, 2026

Other practice locations (NPPES)

2: Phoenix, AZ; Sanford, FL

Pediatric dentistry listings at this street address

1 (only this one)

NPI 1336694116 is active in the federal NPPES registry (CMS) with Pediatric Dentistry, an ADA-recognized dental specialty, as its self-reported primary taxonomy; license D010564 (AZ) is listed on the record. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-10-16.

Public record, not an endorsement. This listing was compiled from public records as of 2026-10-16 and may be incomplete or out of date. Pediatric Dentist Index does not vet, employ, recommend or guarantee pediatric dental practices; a badge reflects only what the public record showed on that date. Confirm current details with the official record before you decide. The information on Pediatric Dentist Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Full disclaimer · Report an error

What these registry facts mean

The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. Pediatric dentists are dentists who completed an accredited pediatric dentistry residency after dental school. A registered specialty is not board certification. Verify the dental license with the state dental board and board certification with the American Board of Pediatric Dentistry.

View NPI 1336694116 in the official registry ↗