Active NPI
Jonathan P Wiens, DDS MSD
- Oral and Maxillofacial Surgery (Dentist)
- West Bloomfield, MI
National Provider Identifier
1497894596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 2901010587
- Practice address
- 6177 Orchard Lake Road
Suite 120
West Bloomfield, MI 48322 - Phone
- (248) 855-6655
- Fax
- (248) 855-0803
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D10587 | MI | |
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 2901010587 | MI | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 2901010587 | MI | Primary |
| Prosthodontics | 1223P0700X | 2901010587 | MI |
Addresses
Primary practice location
6177 Orchard Lake Road
Suite 120
West Bloomfield, MI 48322
Mailing address
6177 Orchard Lake Road
Suite #120
West Bloomfield, MI 48322
Phone (248) 855-6655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1940814 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D10587 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343606400000",
"number": "1497894596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6177 ORCHARD LAKE ROAD",
"address_2": "SUITE #120",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "48322",
"telephone_number": "248-855-6655",
"fax_number": "248-855-0803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6177 ORCHARD LAKE ROAD",
"address_2": "SUITE 120",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "48322",
"telephone_number": "248-855-6655",
"fax_number": "248-855-0803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIENS",
"first_name": "JONATHAN",
"middle_name": "P",
"credential": "DDS MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2012-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "D10587",
"primary": false
},
{
"code": "204E00000X",
"taxonomy_group": "",
"desc": "Oral & Maxillofacial Surgery",
"state": "MI",
"license": "2901010587",
"primary": false
},
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "MI",
"license": "2901010587",
"primary": true
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MI",
"license": "2901010587",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1940814",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.