Kevin Wieczerza, DDS, PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

KEVIN WIECZERZA, DDS, PLLC

Doing business as

Wolverine Family Dentistry

Practice address

4075 Stone School Rd
Ann Arbor, MI 48108-9723

Phone

(734) 971-2200

NPI assigned

Jul 5, 2022

Organization subpart

No

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

Authorized official

Name

Kevin Wieczerza, DDSNPI 1750838397

Title

Owner

Phone

(518) 320-6912

Specialties & licenses 1

Addresses

Other names 1

• Wolverine Family Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin George Wieczerza, D.D.S.

  • Dentist
  • Ann Arbor, MI
  • NPI 1750838397
  NPD Authorized official
• Raymond Thomas Tonks, D.D.S.

  • General Practice Dentistry
  • Ann Arbor, MI
  • NPI 1831140334
  NPD (past)

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656979200000",
    "number": "1295468411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4075 STONE SCHOOL RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089723",
            "telephone_number": "734-971-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4075 STONE SCHOOL RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089723",
            "telephone_number": "734-971-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN WIECZERZA, DDS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-05",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A",
        "authorized_official_last_name": "WIECZERZA",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-320-6912",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wolverine Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Sue Kett, OTR
• John Kettley, MSW
• Tosh Ketz
• Tiffie Manyee Keung, MD
• Kevin T Cook DDS PLLC
• Rachel Elizabeth Key, PA-C
• Sade Christine Keyes, PA-C
• April Diane Keys, NP
• Shafaq Khairi, M.D.
• Minhajuddin Syad Khaja, MD

• Dental Clinic/Center in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.