Michael Scott Wasserman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

1770 1St St
#360
Highland Park, IL 60035-3200

Phone

(847) 432-1416

Fax

(847) 433-6151

NPI assigned

Feb 28, 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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306973029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 1ST ST",
            "address_2": "#360",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600353200",
            "telephone_number": "847-432-1416",
            "fax_number": "847-433-6151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 1ST ST",
            "address_2": "#360",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600353200",
            "telephone_number": "847-432-1416",
            "fax_number": "847-433-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "MICHAEL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yan Wang, LMT
• Bria Wanzung, PT
• Warren Barr North Shore LLC
• Abbi Warren
• Amy Kathleen Rourke Wasserman, APN, CNM
• Daryl Steven Watson Jr., CRNA
• Jane F Watson, ACE, ASFA
• Brian M Weinberg, D.M.D.
• Carol O Weinberg, LCSW
• Ellie R Weinberg, LSW

• General Practice Dentistry in Highland Park, IL
• Providers in Highland Park, IL by specialty
• General Practice Dentistry in Illinois

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.