Colleen Marie Wiese, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN25264 Issued in FL

Practice address

14690 NW 151St Blvd # 20
Alachua, FL 32615-5328

Phone

(386) 462-1771

NPI assigned

Apr 6, 2020

Sex

Female

Sole proprietor

No

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

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.

• Alachua Family Dentistry

  • General Practice Dentistry
  • Alachua, FL
  • NPI 1184802522
  NPD (past)

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1386273878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14690 NW 151ST BLVD # 20",
            "city": "ALACHUA",
            "state": "FL",
            "postal_code": "326155328",
            "telephone_number": "386-462-1771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14690 NW 151ST BLVD # 20",
            "city": "ALACHUA",
            "state": "FL",
            "postal_code": "326155328",
            "telephone_number": "386-462-1771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 SW Archer Rd",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326081135",
            "country_code": "US",
            "telephone_number": "352-376-1611 x10633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIESE",
        "first_name": "COLLEEN",
        "middle_name": "MARIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN25264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Jean Walther, RN
• Teresa Ward
• Sarah Ann Warren, APRN, FNP-BC
• We Care Home Health Services
• Mary Whitehurst, LCSW
• Raisa Wilkens
• Alexandrea Danielle Williams, DC
• David Brian Wolf, PH.D., L.C.S.W.
• Lauren Womack
• Chelsea Wooten, PHARMD

• Dentist in Alachua, FL
• Providers in Alachua, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2022; 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.