Andrew P. Wightman, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DE60325350 Issued in WA

Practice address

6050 Tacoma Mall Blvd Suite 330
Tocoma, WA 98409

Phone

(253) 473-0651

Fax

(253) 444-0761

NPI assigned

Jun 8, 2007

Last updated

Dec 5, 2016By the provider in NPPES

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 19, 2017 through Jul 19, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Evergreen Oral Surgery

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Tacoma, WA
  • NPI 1811586761
  NPD

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1083817878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 TACOMA MALL BLVD, SUITE 330",
            "city": "TOCOMA",
            "state": "WA",
            "postal_code": "98409",
            "telephone_number": "253-473-0651",
            "fax_number": "253-444-0761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6050 TACOMA MALL BLVD SUITE 330",
            "city": "TOCOMA",
            "state": "WA",
            "postal_code": "98409",
            "telephone_number": "253-473-0651",
            "fax_number": "253-444-0761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGHTMAN",
        "first_name": "ANDREW",
        "middle_name": "P.",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WA",
            "license": "DE60325350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.