Bradley Wisowaty

Primary specialty

DentistTaxonomy code 122300000X

License

12012301A Issued in IN

Practice address

809 Wall St Ste a
Valparaiso, IN 46383-2571

Phone

(219) 464-9681

NPI assigned

Jul 7, 2015

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Brad Wisowaty DDS LLC

  • Dental Clinic/Center
  • Valparaiso, IN
  • NPI 1609565910
  NPD

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543276800000",
    "number": "1306229562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 WALL ST STE A",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 WALL ST STE A",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832571",
            "telephone_number": "219-464-9681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISOWATY",
        "first_name": "BRADLEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-07",
        "last_updated": "2018-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12012301A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012301A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wade Wilson
• Whitney Anne Winkel, PTA
• Winston Rayburn Counseling Services, LLC
• Christopher M Wirsing, D.O.
• Michele Murphy Wise, RDN, MHA
• Marybeth Witcher, F.N.P.
• Umparrys Lynne' Witherspoon, DNP, RN, FNP-BC
• Allison Witte
• Erin Elaine Woike, M.A.
• Womens Medical Care LLC

• Dentist in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2018; 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.