Carol Wiese, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D1361 Issued in SD

Practice address

700 Sheridan Lake Rd.
Rapid City, SD 57702

Phone

(605) 721-6634

Fax

(605) 341-5757

NPI assigned

May 30, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Dentist

Education

University of Michigan School of Dentistry, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Great Plains Tribal Chairmen'S Health Board

  • Pharmacy
  • Rapid City, SD
  • NPI 1376105452

  TX

  Medicare reassignment
• Black Hills Pediatric Dentistry

  • Community Health Worker
  • Rapid City, SD
  • NPI 1538889738

  Pediatric Dentistry

  NPD
• Black Hills Pediatric Dentistry

  • Pediatric Dentistry
  • Rapid City, SD
  • NPI 1194867499
  NPD (past)

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

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1215374335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SHERIDAN LAKE RD",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577022407",
            "telephone_number": "605-721-6634",
            "fax_number": "605-341-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SHERIDAN LAKE RD.",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "57702",
            "telephone_number": "605-721-6634",
            "fax_number": "605-341-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "CAROL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-30",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020964",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SD",
            "license": "D1361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhianna Wickett, DPT
• Kelly Wicks, RBT
• Dan A Wiebe, MA
• Susan Wiedmeier, OT
• Bryant Wieking, PA
• Trina Wilcken, MS, LPC-MH
• Darlene Marie Wilcox, PH.D., LP
• Evelyn Iris Wilder, LPC-MH, QMHP, LAC
• Carolyn Sue Wildhaber, CSW-PIP
• Wilen Dentistry PLLC

• Pediatric Dentistry in Rapid City, SD
• Providers in Rapid City, SD by specialty
• Pediatric Dentistry in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.