Thamer Wisam

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401417688 Issued in VA

Practice address

30 Courthouse Rd
North Chesterfield, VA 23236-3124

Phone

(804) 794-2026

NPI assigned

Aug 27, 2021

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 VA

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

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.

• Absolute Dental Care / MW Dental

  • General Practice Dentistry
  • Gainesville, VA
  • NPI 1174450514
  NPD Authorized official

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1396412151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 COURTHOUSE RD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363124",
            "telephone_number": "804-794-2026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 COURTHOUSE RD",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232363124",
            "telephone_number": "804-794-2026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISAM",
        "first_name": "THAMER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401417688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Minique Winfree
• Jordan Winn
• Amelia Lucinda Woodson Winston, LPN
• Winston'S Residential, LLC
• Taryn Alyssa Winters, DPT
• Jordan Witt, DPT
• Christopher Wolberg, DDS
• Mandi M Wolfe, FPN
• Womens Wellness Center of Virginia, LLC
• Philip Wong, PHARM.D.

• General Practice Dentistry in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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.