Active NPI
Tomasz Adam Wietecha, L.D., M.D.
- Denturist
- Port Orchard, WA
National Provider Identifier
1063755783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Denturist
- License
- DN60186659
- Practice address
- 3965 Bethel Rd SE
Ste 2C
Port Orchard, WA 98366-1976 - Phone
- (360) 876-0508
- NPI assigned
- Apr 1, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | DN60186659 | WA | Primary |
Addresses
Primary practice location
3965 Bethel Rd SE
Ste 2C
Port Orchard, WA 98366-1976
Mailing address
3965 Bethel Rd SE
Ste 2C
Port Orchard, WA 98366-1976
Phone (360) 876-0508
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN60186659 | WA | MD | Denturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489968000000",
"number": "1063755783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3965 BETHEL RD SE",
"address_2": "STE 2C",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983661976",
"telephone_number": "360-876-0508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3965 BETHEL RD SE",
"address_2": "STE 2C",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983661976",
"telephone_number": "360-876-0508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIETECHA",
"first_name": "TOMASZ",
"middle_name": "ADAM",
"name_prefix": "Dr.",
"credential": "L.D., M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-01",
"last_updated": "2017-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "122400000X",
"taxonomy_group": "",
"desc": "Denturist",
"state": "WA",
"license": "DN60186659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orchard, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.