NPIMap

Organization Active NPI

Cosmetic & General Dentistry of Winthrop

  • Dental Clinic/Center
  • Winthrop, ME
National Provider Identifier
1407029184
Registry record updated Apr 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
3627 Issued in ME
Legal business name
COSMETIC & GENERAL DENTISTRY OF WINTHROP
Practice address
28 Old Western Ave
Winthrop, ME 04364-4060
Phone
(207) 377-6958
Fax
(207) 377-4349
NPI assigned
Apr 2, 2008
Last updated
Apr 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2008

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

Authorized official

Name
Dr. Jay R Wietecha, DMD
Title
Owner
Phone
(207) 377-6958

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 3627 ME Primary
Dental Clinic/Center 261QD0000X 2556 ME

Addresses

Primary practice location

28 Old Western Ave
Winthrop, ME 04364-4060

Mailing address

28 Old Western Ave
Winthrop, ME 04364-4060
Phone (207) 377-6958

National Provider Directory

National Provider Directory
Tax ID family
Cosmetic General Dentistry of Winthrop2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1407029184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 OLD WESTERN AVE",
            "city": "WINTHROP",
            "state": "ME",
            "postal_code": "043644060",
            "telephone_number": "207-377-6958",
            "fax_number": "207-377-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 OLD WESTERN AVE",
            "city": "WINTHROP",
            "state": "ME",
            "postal_code": "043644060",
            "telephone_number": "207-377-6958",
            "fax_number": "207-377-4349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSMETIC & GENERAL DENTISTRY OF WINTHROP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "WIETECHA",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-377-6958",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ME",
            "license": "3627",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ME",
            "license": "2556",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winthrop, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; 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.