Michael Dean Wooten, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS4213 Issued in TN

Practice address

6207 Highland Place Way
Suite 207
Knoxville, TN 37919-4027

Phone

(865) 584-6207

Fax

(865) 934-0080

NPI assigned

Mar 29, 2007

Last updated

Jul 9, 2007By 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

Other identifiers 3

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Oct 1, 2014 through Oct 1, 2026

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Knoxville Oral & Maxillofacial Surgery

  • Dentist
  • Knoxville, TN
  • NPI 1598746927
  Authorized official Same address or phone
• Knoxville Center for Oral & Maxillofacial Surgery, PC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Oak Ridge, TN
  • NPI 1891298337
  NPD (past)
• TN Oms Specialty Dental Services, PLLC

  dba Knoxville Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Knoxville, TN
  • NPI 1982461927
  NPD (past)

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1194845982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6207 HIGHLAND PLACE WAY",
            "address_2": "SUITE 207",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379194027",
            "telephone_number": "865-584-6207",
            "fax_number": "865-934-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6207 HIGHLAND PLACE WAY",
            "address_2": "SUITE 207",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379194027",
            "telephone_number": "865-584-6207",
            "fax_number": "865-934-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOTEN",
        "first_name": "MICHAEL",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS4213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3225414",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "4000149",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "DS4213",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paul Douglas Wooldridge, M.D.
• William Henry Wooldridge, M.D.
• Krystal Trenchfield Woolman, PA-C
• Destinie Marie Woolridge
• B. David Wooten, MD
• Ruth Wooten, RD, LDN, CNSC
• Zechariah Wooten
• Ronnie Scott Word, D.D.S.
• Workforce Recovery Inc
• Stacia Working, M.S. CF-SLP

• Oral and Maxillofacial Surgery (Dentist) in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.