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DR. MARK M WILSON D.D.S.
NPI 1588735823
Dentist - Periodontics in Minneapolis, MN

Active since November 10, 2006Opted out of Medicare · through Dec 29, 2027
825 NICOLLET MALL, SUITE 210, MINNEAPOLIS, MN 55402(612) 332-0869(612) 332-2891 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Dr. Mark M Wilson D.d.s. NPPES

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

DR. MARK M WILSON D.D.S. (NPI 1588735823) is an individual periodontics provider in Minneapolis, Minnesota, licensed in Minnesota (8580) and active in the NPI registry since November 2006. He has opted out of Medicare through December 29, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1588735823
Entity TypeIndividualMale
Primary Taxonomy1223P0300X
Provider Legal NameDR. MARK M WILSONCredential: D.D.S.
Location Address825 NICOLLET MALL, SUITE 210Minneapolis, MN 55402-2606
Mailing Address825 Nicollet Mall, Suite 210Minneapolis, MN 55402-2606 · (612) 332-0869 · Fax (612) 332-2891
Phone(612) 332-0869
Fax(612) 332-2891
Sole ProprietorYes
Enumeration DateNovember 10, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1588735823 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in MN · 8580
Definition
That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
825 NICOLLET MALL, Minneapolis, MN 55402
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Mark M Wilson D.d.s. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 29, 2017 through December 29, 2027.

Opt-Out Effective DateDecember 29, 2017
Opt-Out In Effect ThroughDecember 29, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55402 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
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
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.

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.

DR. VIRGINIA ANNE MCDERMOTT PH.D.
Psychologist
825 NICOLLET MALL, SUITE 1630
MINNEAPOLIS, MN 55402
Hennepin County (612) 673-9988
SKIN SPECIALISTS, LTD.
Dermatology
825 NICOLLET MALL, SUITE 1002
MINNEAPOLIS, MN 55402
Hennepin County (612) 338-0711
DR. GARY M FINE
Dentist
825 NICOLLET MALL
MINNEAPOLIS, MN 55402
Hennepin County (612) 332-1336
BIRCHWOOD DENTAL OF MINNEAPOLIS
Dentist (General Practice)
825 NICOLLET MALL, 829 MEDICAL ARTS BLDG
MINNEAPOLIS, MN 55402
Hennepin County (612) 333-8677
DOWNTOWN SKYWAY FOOT SPECIALISTS INC
Podiatrist (Foot Surgery)
825 NICOLLET MALL, SUITE 517 MEDICAL ARTS BLDG
MINNEAPOLIS, MN 55402
Hennepin County (612) 332-7720
ADVANCED FOOT CARE CLINIC,LTD
Podiatrist
825 NICOLLET MALL, SUITE 601
MINNEAPOLIS, MN 55402
Hennepin County (763) 550-1013
MARK ALAN JOHNSON D.C.
Chiropractor
825 NICOLLET MALL, STE 1845
MINNEAPOLIS, MN 55402
Hennepin County (612) 332-8292
PAIN & INJURY CENTER PLLC
Physical Medicine & Rehabilitation (Pain Medicine)
825 NICOLLET MALL, SUITE #1453
MINNEAPOLIS, MN 55402
Hennepin County (612) 886-1562

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Wilson's NPI number?

The NPI number for Mark Wilson is 1588735823. It was assigned to this individual provider in the NPPES registry on November 10, 2006.

Where is Mark Wilson located?

Mark Wilson practices at 825 Nicollet Mall Suite 210, Minneapolis, MN 55402. The listed phone number is (612) 332-0869.

What is Mark Wilson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Mark Wilson enrolled in Medicare?

No. Mark Wilson has opted out of Medicare through December 29, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Mark Wilson was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.