DR. JARELL LAMONZ WILSON D.D.S.
NPI 1336694116
Dentist - Pediatric Dentistry in Peridot, AZ

Q: What is Jarell Wilson's NPI number?

The NPI number for Jarell Wilson is 1336694116. It was assigned to this individual provider in the NPPES registry on August 22, 2016.

Q: What is Jarell Wilson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Jarell Wilson was last updated on June 12, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since August 22, 2016PECOS Enrolled

103 MEDICINE WAY RD, PERIDOT, AZ 85542(928) 475-1495 Get Directions Write a Review

NPPES record last updated: June 12, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 25, 2020, Dec 11, 2018, Sep 15, 2016 and 1 more (4 updates tracked since 2016).

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About Dr. Jarell Lamonz Wilson D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JARELL LAMONZ WILSON D.D.S. (NPI 1336694116) is an individual pediatric dentistry provider in Peridot, Arizona, licensed in Arizona (D010564) and active in the NPI registry since August 2016. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1336694116

Entity TypeIndividualMale

Primary Taxonomy1223P0221X

Provider Legal NameDR. JARELL LAMONZ WILSONCredential: D.D.S.

Location Address103 MEDICINE WAY RDPeridot, AZ 85542-5000

Mailing Address360 S Mellonville AveSanford, FL 32771-1453 · (843) 593-5905

Phone(928) 475-1495

Sole ProprietorYes

Enumeration DateAugust 22, 2016

Last NPPES UpdateJune 12, 20264 updates tracked since enumeration

NPPES CertifiedJune 12, 2026

✔ NPI 1336694116 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

Licenses✔ Licensed in AZ · D010564✔ Licensed in FL · DN31327

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Also ListedDentist · Dental Public HealthTaxonomy 1223D0001X · License D010564 (AZ)

Also ListedDentist · General PracticeTaxonomy 1223G0001X · License 059461 (NY)

103 MEDICINE WAY RD, Peridot, AZ 85542

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Secondary Practice Locations 2

Location 11934 E Camelback Rd Ste 110Phoenix, AZ 85016-4136 · Phone (602) 833-2564

Location 2360 S Mellonville AveSanford, FL 32771-1453 · Phone (480) 492-1059

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jarell Lamonz Wilson D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85542 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$69.24 typical visit price

range $17.72 – $137.41

Typical copayment $17.31 (range $4.43 – $34.35)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMANDA HUBER

Dietitian, Registered