Richard W. Wiedeman, DDS, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

NC7085 Issued in NC

Legal business name

RICHARD W. WIEDEMAN, DDS, PA

Practice address

15 Jane Jacobs Rd
Suite 201
Black Mountain, NC 28711-6306

Phone

(828) 210-7051

Fax

(828) 210-7052

NPI assigned

Mar 28, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Richard William Wiedeman, D.D.S.NPI 1528102027

Title

President

Phone

(828) 210-7051

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard William Wiedeman, D.D.S.

  • General Practice Dentistry
  • Black Mountain, NC
  • NPI 1528102027

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375056000000",
    "number": "1124290218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 JANE JACOBS RD",
            "address_2": "SUITE 201",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287116306",
            "telephone_number": "828-210-7051",
            "fax_number": "828-210-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 JANE JACOBS RD",
            "address_2": "SUITE 201",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287116306",
            "telephone_number": "828-210-7051",
            "fax_number": "828-210-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD W. WIEDEMAN, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-28",
        "last_updated": "2013-07-29",
        "status": "A",
        "authorized_official_last_name": "WIEDEMAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-210-7051",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "NC7085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89012MJ",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Black Mountain, NC
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2013; 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.