Active NPI
Michael James Wisnoski, DDS
- General Practice Dentistry
- Pearland, TX
National Provider Identifier
1073708368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 19057
- Practice address
- 1819 Broadway St Ste 105
Pearland, TX 77581-5671 - Phone
- (281) 648-4000
- Fax
- (281) 648-4001
- NPI assigned
- Sep 10, 2007
- Last updated
- Sep 10, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 19057 | TX | Primary |
Addresses
Primary practice location
1819 Broadway St Ste 105
Pearland, TX 77581-5671
Mailing address
1819 Broadway St Ste 105
Pearland, TX 77581-5671
Phone (281) 648-4000
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
| License | State | Type | Specialty |
|---|---|---|---|
| 19057 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nooshei P.a. | General Practice | Past | Accepting new patients |
Interoperability endpoints
- michael.wisnoski.1@19643.direct.athenahealth.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1073708368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1819 BROADWAY ST STE 105",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775815671",
"telephone_number": "281-648-4000",
"fax_number": "281-648-4001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1819 BROADWAY ST STE 105",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775815671",
"telephone_number": "281-648-4000",
"fax_number": "281-648-4001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISNOSKI",
"first_name": "MICHAEL",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-10",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "19057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.