Barry Craig Widdicombe, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7537 Issued in IN

Practice address

3804 N Delaware St
Indianapolis, IN 46205-2648

Phone

(317) 925-4202

Fax

(317) 923-1507

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

No

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

Enrolled in IN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• My Indy Dental Center LLC

  • Dental Clinic/Center
  • Indianapolis, IN
  • NPI 1265101315
  NPD (past)

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144348178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3804 N DELAWARE ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462052648",
            "telephone_number": "317-925-4202",
            "fax_number": "317-923-1507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3804 N DELAWARE ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462052648",
            "telephone_number": "317-925-4202",
            "fax_number": "317-923-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDDICOMBE",
        "first_name": "BARRY",
        "middle_name": "CRAIG",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "7537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Skyler Wickstrom
• Jennifer Nicole Wickware, RD, CD
• Frederick Wickwire, CRNA
• Wicz LLC
• Krystal Althea Renner Widau, D.O.
• Dorota Widelka
• Meghan Elizabeth Widrig, NP
• Eric Alan Wiebke, M.D.
• Michelle Wiebke
• Wiecare Home Care LLC

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.