NPIMap

Individual provider Active NPI

Chad Michael Wiese, D.D.S.

  • General Practice Dentistry
  • Washington, IA
National Provider Identifier
1043265200
Registry record updated Oct 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
08209 Issued in IA
Practice address
1004 E Washington St
Washington, IA 52353-2149
Phone
(319) 653-2201
Fax
(319) 653-5548
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 08209 IA Primary

Addresses

Primary practice location

1004 E Washington St
Washington, IA 52353-2149

Mailing address

1004 E Washington St
Washington, IA 52353-2149
Phone (319) 653-2201

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
08209IAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Wiese Family Dental Past Accepting new patients
Restoration Dental and Implant Center, PC General Practice PastSince Oct 29, 2023 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414454400000",
    "number": "1043265200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 E WASHINGTON ST",
            "city": "WASHINGTON",
            "state": "IA",
            "postal_code": "523532149",
            "telephone_number": "319-653-2201",
            "fax_number": "319-653-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 E WASHINGTON ST",
            "city": "WASHINGTON",
            "state": "IA",
            "postal_code": "523532149",
            "telephone_number": "319-653-2201",
            "fax_number": "319-653-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "CHAD",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2014-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "08209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.