Jay Wietecha, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3627 Issued in ME

Practice address

98 Silver St
Waterville, ME 04901-5935

Phone

(207) 873-2073

Fax

(207) 873-0697

NPI assigned

Feb 28, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Esthetic and Reconstructive Dentistry

  • Dental Clinic/Center
  • Waterville, ME
  • NPI 1578735320
  NPD (past)

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1306973078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 SILVER ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049015935",
            "telephone_number": "207-873-2073",
            "fax_number": "207-873-0697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 SILVER ST",
            "city": "WATERVILLE",
            "state": "ME",
            "postal_code": "049015935",
            "telephone_number": "207-873-2073",
            "fax_number": "207-873-0697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETECHA",
        "first_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-28",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "3627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura-Lee A Wheeler
• Lisa Joy White
• Janet Sweeney Whitten, LMSW/C
• Emily Widor, LCSW
• Diane L Wiegand
• John M. Wilcox, MS, OTR/L
• April Wild
• Wildflower Occupational Therapy (Wildflower Pediatric Therapy)
• William E. Bennett, M.D. P.a
• Victoria Paige Wilson Townley, LCSW

• General Practice Dentistry in Waterville, ME
• Providers in Waterville, ME by specialty
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.