NPIMap

Individual provider Active NPI

Scott C Wietecha, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Columbia, SC
National Provider Identifier
1114092707
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
2148 Issued in SC
Practice address
7033 Saint Andrews Rd
Suite 102
Columbia, SC 29212-1179
Phone
(803) 781-3321
Fax
(803) 781-4406
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 2148 SC Primary

Addresses

Primary practice location

7033 Saint Andrews Rd
Suite 102
Columbia, SC 29212-1179

Mailing address

7033 Saint Andrews Rd
Suite 102
Columbia, SC 29212-1179
Phone (803) 781-3321

Other identifiers 2

IdentifierTypeStateIssuer
2148OtherSCDENTAL LICENSE
ZZ2148MedicaidSC

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
2418SCMDPhysical Therapy Assistant
2148SCMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
DDS Services, LLC Oral and Maxillofacial Surgery PastSince Nov 2, 2006 Accepting new patients
Associates in Oral & Maxillofacial Surgery, PA Oral and Maxillofacial Surgery Past Accepting new patients
Associates in Oral & Maxillofacial Surgery, PA Oral and Maxillofacial Surgery Past Accepting new patients
DRS Farrell, Farrell, Nale, Cook, Kapitan, Mohamed, Franco, Wessel, Ho Past Accepting new patients

Organizations & group practices 4

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": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114092707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 SAINT ANDREWS RD",
            "address_2": "SUITE 102",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292121179",
            "telephone_number": "803-781-3321",
            "fax_number": "803-781-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7033 SAINT ANDREWS RD",
            "address_2": "SUITE 102",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292121179",
            "telephone_number": "803-781-3321",
            "fax_number": "803-781-4406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETECHA",
        "first_name": "SCOTT",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "SC",
            "license": "2148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "2148",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZ2148",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.