Robert Edward Widis, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

5062 Issued in NC

Practice address

5232 Albemarle Rd
Suite C
Charlotte, NC 28212-2659

Phone

(704) 536-6774

Fax

(704) 536-5998

NPI assigned

Dec 18, 2006

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

Enrolled in NC

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.

• Tadrissi DDS, PLLC

  dba Queen City Endodontics - Lake Norman

  • Endodontics
  • Mooresville, NC
  • NPI 1255818944
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215090998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5232 ALBEMARLE RD",
            "address_2": "SUITE C",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282122659",
            "telephone_number": "704-536-6774",
            "fax_number": "704-536-5998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5232 ALBEMARLE RD",
            "address_2": "SUITE C",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282122659",
            "telephone_number": "704-536-6774",
            "fax_number": "704-536-5998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDIS",
        "first_name": "ROBERT",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NC",
            "license": "5062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Case Wickline
• Wickshire Steele Creek Opco, LLC
• Jeffrey S. Widelitz, MD
• Chantel Wideman
• Alexandria Widener, LCMHCA
• Monica Widmeyer
• Nicholas Wieczorek, MD
• Jean L Wiegand, CRNA
• Craig Wiehe Jr., DPT
• Cindy E Wiener, DC

• Endodontics in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Endodontics in North Carolina

• 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.