NPIMap

Organization Active NPI

Thomas R. Wiedemann, DDS,PC

  • Dental Clinic/Center
  • Saint Louis, MO
National Provider Identifier
1245390798
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
13165 Issued in MO
Legal business name
THOMAS R. WIEDEMANN, DDS,PC
Practice address
3707 Watson Rd
Saint Louis, MO 63109-1236
Phone
(314) 645-6400
NPI assigned
Dec 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thomas R Wiedemann, DDSNPI 1790782399
Title
President
Phone
(314) 645-6400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 13165 MO Primary

Addresses

Primary practice location

3707 Watson Rd
Saint Louis, MO 63109-1236

Mailing address

3707 Watson Rd
Saint Louis, MO 63109-1236
Phone (314) 645-6400

National Provider Directory

National Provider Directory

Locations

3707 Watson Rd
Saint Louis, MO 63109
Phone (314) 645-6400

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245390798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 WATSON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631091236",
            "telephone_number": "314-645-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 WATSON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631091236",
            "telephone_number": "314-645-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS R. WIEDEMANN, DDS,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WIEDEMANN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-645-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MO",
            "license": "13165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.