Dennis R. Wicks, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2094 Issued in SD

Practice address

25224 Holiday TRL
Custer, SD 57730-8342

Phone

(605) 673-2689

Fax

(605) 673-2689

NPI assigned

Jun 4, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235331992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25224 HOLIDAY TRL",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577308342",
            "telephone_number": "605-673-2689",
            "fax_number": "605-673-2689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25224 HOLIDAY TRL",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577308342",
            "telephone_number": "605-673-2689",
            "fax_number": "605-673-2689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKS",
        "first_name": "DENNIS",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SD",
            "license": "2094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gloria D Walz, CNP
• Connor Eugene Weisser, DO
• Allen Andrew Wellman, MD
• Christopher James Wenger, M.D.
• Danielle Wheeler, DPT
• Nathan Henry Wiederholt, O.D.
• Vernon Wong, OD
• Word of Mouth, Inc
• John Robert Zent, DDS
• Jennifer N Zettl, DNP,FNP-C, CNP

• Family Medicine Physician in Custer, SD
• Providers in Custer, SD by specialty
• Family Medicine Physician in South Dakota

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.