Christopher B. Wiley, D.D.S.
Individual provider Active NPI Dentist · Saugatuck, MI
NPI 1013021989 · NPPES record last updated Oct 11, 2022
Key facts
- NPI
- 1013021989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 143490 (MI)
- Practice address
- 6515 Blue Star Highway
Saugatuck, MI 49453-1108 - Phone
- (269) 857-1496
- Fax
- (269) 857-4791
- NPI assigned
- Aug 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170111003559 | MI | Order and Referring Only - Dentist |
1658652326 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 143490 | MI | MD | Dentist |
| 143490 | OH | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 143490 | MI | Yes |
| General Practice Dentistry | 1223G0001X | 143490 | OH |
Addresses
Primary practice location
6515 Blue Star Highway
Saugatuck, MI 49453-1108
Mailing address
PO Box 1108
Saugatuck, MI 49453-1108
Phone (269) 857-1496
Other providers in Saugatuck, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.