Dr Jarell Lamonz Wilson, DDS is a medicare enrolled "Dentist - Pediatric Dentistry" provider in Peridot, Arizona. His current practice location is
103 Medicine Way Rd, Peridot, Arizona. You can reach out to his office (for appointments etc.) via phone at
(928) 475-1495.
Dr Jarell Lamonz Wilson is licensed to practice in Arizona (license number D010564) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1336694116.
Healthcare Provider's Profile
| Full Name | Dr Jarell Lamonz Wilson |
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| Gender | Male |
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| Speciality | Dentist - Pediatric Dentistry |
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| Location | 103 Medicine Way Rd, Peridot, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1336694116
- Provider Enumeration Date: 08/22/2016
- Last Update Date: 06/12/2026
Medicare PECOS Information:
- PECOS PAC ID: 8022357334
- Enrollment ID: I20240104002381
Medical Identifiers
Medical identifiers for Dr Jarell Lamonz Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1336694116 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 1223D0001X | Dentist - Dental Public Health | D010564 (Arizona) | Secondary |
| 1223G0001X | Dentist - General Practice | 059461 (New York) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | DN31327 (Florida) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | D010564 (Arizona) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Jarell Lamonz Wilson allows following entities to bill medicare on his behalf.
| Entity Name | San Carlos Apache Healthcare Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1265813075
PECOS PAC ID: 0648580597
Enrollment ID: O20151105002091 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jarell Lamonz Wilson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Jarell Lamonz Wilson, DDS
360 S Mellonville Ave,
Sanford, FL 32771-1453
Ph: (843) 593-5905 | Dr Jarell Lamonz Wilson, DDS
103 Medicine Way Rd,
Peridot, AZ 85542-5000
Ph: (928) 475-1495 |
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