Grant Matthew Wiswell, MD, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2433 Issued in MT

Practice address

3020 S Reserve St Ste C
Missoula, MT 59801-7652

Phone

(406) 541-2180

Fax

(406) 541-2188

NPI assigned

Jun 25, 2008

Last updated

Oct 7, 2025By 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 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Oct 8, 2018 through Oct 8, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759795200000",
    "number": "1497917132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST STE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017652",
            "telephone_number": "406-541-2180",
            "fax_number": "406-541-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 S RESERVE ST STE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598017652",
            "telephone_number": "406-541-2180",
            "fax_number": "406-541-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISWELL",
        "first_name": "GRANT",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD, DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MT",
            "license": "2433",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MT",
            "license": "2433",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MT",
            "license": "12707",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Dawn Wiseman
• Chalynne Marie Wisniewski, MAT, LAT, ATC
• Nadine M. Wisniewski, PH.D.
• Zachary Allen Wisniewski, MAT, LAT, ATC
• Jason Patrick Wissinger, MD
• Without Limits, Inc.
• Zackery W Witte, M.D.
• Carissa Marie Woelich, OD
• Christian Wold, LMSW
• Rochelle Suzanne Wolfe, M.D.

• Dentist in Missoula, MT
• Providers in Missoula, MT by specialty
• Dentist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2025; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.