John P Wiederholt, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

6263-15 Issued in WI

Practice address

3434 E. Washington Ave
Madison, WI 53704-4155

Phone

(608) 443-5550

Fax

(608) 443-5554

NPI assigned

Apr 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1336369073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 W. BELTLINE HWY.",
            "address_2": "STE. 120",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537134226",
            "telephone_number": "608-443-5500",
            "fax_number": "608-441-1981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 E. WASHINGTON AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537044155",
            "telephone_number": "608-443-5550",
            "fax_number": "608-443-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDERHOLT",
        "first_name": "JOHN",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "21644",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6263-015",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6263-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Rae Wiechman, PHARM.D
• Gabrielle Wied, RN
• Beth A Wiedel, M.D.
• Sheena Lee Wiedenfeld, MASTERS COUNSELING
• Frances Wiedenhoeft, CRNA
• Paige Wiederholt, PHARMD
• Derek Wiedmeyer, CAA
• Makayla Lynn Wiegand, MS, MFT-IT
• Joshua Wiegel, PHARMD, BCTXP
• Quade R Wiegel, PA-C

• Dentist in Madison, WI
• Providers in Madison, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; 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.