Healthcare Provider Details

I. General information

NPI: 1699600759
Provider Name (Legal Business Name): SIERRA WILSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 E STATE ROUTE 350
RAYTOWN MO
64133-5717
US

IV. Provider business mailing address

2580 FOREST AVE UNIT 302
KANSAS CITY MO
64108-3521
US

V. Phone/Fax

Practice location:
  • Phone: 816-503-9011
  • Fax: 816-503-9298
Mailing address:
  • Phone: 816-503-9011
  • Fax: 816-503-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2026026776
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: