Sam Wise, DDS, MOM, MSC, MDS

Primary specialty

Orofacial Pain DentistryTaxonomy code 1223X2210X

License

35081 Issued in TX

Practice address

3045 N Goliad St Ste 105
Rockwall, TX 75087-7097

Phone

(972) 722-9100

NPI assigned

Mar 16, 2019

Last updated

Jan 9, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tesla Dental Implant LLC

  • Orofacial Pain Dentistry
  • Keller, TX
  • NPI 1487398285
  NPD Authorized official
• German Wise Dental LLC

  dba Lower Columbia Oral Health

  • Oral and Maxillofacial Surgery (Dentist)
  • Longview, WA
  • NPI 1518520170
  NPD Authorized official

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

{
    "created_epoch": "1552694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1417416728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 TIMBER LN",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750361743",
            "telephone_number": "973-747-6425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3045 N GOLIAD ST STE 105",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750877097",
            "telephone_number": "972-722-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2700 W University Dr Ste 1060",
            "address_purpose": "LOCATION",
            "city": "Denton",
            "state": "TX",
            "postal_code": "762011607",
            "country_code": "US",
            "telephone_number": "940-382-5900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISE",
        "first_name": "SAM",
        "name_prefix": "Prof.",
        "credential": "DDS, MOM, MSC, MDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-16",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "35081",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "60795714",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "35081",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "35081",
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "TX",
            "license": "35081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI II",
            "identifier": "1518520170",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI II",
            "identifier": "1487398285",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "professorwise.us",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3045 N Goliad St Ste 105",
            "city": "Rockwall",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750877097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "professorwise.us",
            "affiliation": "N",
            "endpointDescription": "self",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3045 N Goliad St Ste 105",
            "city": "Rockwall",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750877097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cody Lee Wimpee
• Jania Winn
• Winning Edge Employment Services LLC
• Winning Edge Employment Services LLC
• Amber Foster Winter, LPC
• Elizabeth C Wolf, RNC WHCNP
• Angelin Renee Wolfe, LMSW
• Holly Woodlee, BSN, RN
• Joanette Woods, LPC
• Daniel Alan Woodward, D.C.

• Orofacial Pain Dentistry in Rockwall, TX
• Providers in Rockwall, TX by specialty
• Orofacial Pain Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; 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.