Michael Thomas Wiernicki

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

22302 Issued in FL

Practice address

1074 Spring Lake Plaza
Winter Haven, FL 33881

Phone

(561) 289-4374

NPI assigned

Dec 21, 2018

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

Opted out of Medicare

Yes, effective Mar 1, 2019 through Mar 1, 2027

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 and National Provider Directory roles.

• Mra Orthodontics PA

  dba OrthoMike Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Wellington, FL
  • NPI 1770352346
  NPD Authorized official
• Orthomike Orthodontics PA

  • Dental Clinic/Center
  • Boca Raton, FL
  • NPI 1285252023
  NPD Authorized official

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

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1356813869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5717 TRACE MEADOW LOOP APT 304",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335782625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1074 SPRING LAKE PLAZA",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "33881",
            "telephone_number": "561-289-4374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERNICKI",
        "first_name": "MICHAEL",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-21",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "22302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tashna Cassandra Whyte, LPTA
• Dale Wickstrom-Hill, DO
• Linda G Widner, ARNP
• Deborah Wieben
• Paul T Wielebinski, M.D.
• Amber Lee Wiertel, COTA
• Ashley Rose Wilk, D.O.
• Deborah M Wilkerson, ARNP-C, MSN, COHN-S
• Alicia Wilkinson-Dickens, LCSW
• Edgar H Willard, M.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.