John Andrew Wakeman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

54315 Issued in CA

Practice address

1090 Dolliver St
Pismo Beach, CA 93449-2508

Phone

(805) 773-2500

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1063505832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 DOLLIVER ST",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492508",
            "telephone_number": "805-773-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 DOLLIVER ST",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492508",
            "telephone_number": "805-773-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKEMAN",
        "first_name": "JOHN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "54315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Valdez, ND
• Kendra Kendra Varney, M.S.
• Michael R. Velarde, M.D.
• Ventana Health and Medical Center
• Dale A Vonruden, M.D.
• Alice Wallack, MD
• Alison Watt, PA-C
• Amy E. Webb, M.D.
• Marc W. Weise, M.D.
• Shonra Anne Weiss, NP

• General Practice Dentistry in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.