Active NPI
Ryan Wiesemann, DMD, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- White House, TN
National Provider Identifier
1235286105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 8503
- Practice address
- 323 West Dr
White House, TN 37188-9294 - Phone
- (615) 325-4677
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 8503 | TN | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 8125 | KY |
Addresses
Primary practice location
323 West Dr
White House, TN 37188-9294
Mailing address
894 Fred Lively Rd
Bowling Green, KY 42104-7424
Phone (615) 325-4677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8125 | KY | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 8503 | TN | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306800000000",
"number": "1235286105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "894 FRED LIVELY RD",
"city": "BOWLING GREEN",
"state": "KY",
"postal_code": "421047424",
"telephone_number": "615-325-4677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "323 WEST DR",
"city": "WHITE HOUSE",
"state": "TN",
"postal_code": "371889294",
"telephone_number": "615-325-4677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIESEMANN",
"first_name": "RYAN",
"name_prefix": "Dr.",
"credential": "DMD, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2011-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TN",
"license": "8503",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "KY",
"license": "8125",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White House, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.