Ryan Wisdom, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

059915 Issued in NY

Practice address

75 Dolson Ave
Middletown, NY 10940-6501

Phone

(845) 476-3888

NPI assigned

Jun 25, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1498348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544054400000",
    "number": "1528588167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 DOLSON AVE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109406501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 DOLSON AVE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109406501",
            "telephone_number": "845-476-3888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Main St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Brewster",
            "state": "NY",
            "postal_code": "105091521",
            "country_code": "US",
            "telephone_number": "845-279-6999",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 Grace Church St",
            "address_purpose": "LOCATION",
            "city": "Port Chester",
            "state": "NY",
            "postal_code": "105734911",
            "country_code": "US",
            "telephone_number": "914-937-8899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISDOM",
        "first_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-25",
        "last_updated": "2018-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "059915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chara Winckler
• Windsor Counseling Group
• Windsor Counseling West
• Kyle Matthew Winkler, LCSW
• Caitlin Sarah Winters, CRNA
• Constance Wit, RN
• Kate G Witt, LCSW
• Kathryn Wittenberg, PHARM.D.
• Melissa Lynn Wixon, FNP-BC
• Michael L Wodka, DPM

• General Practice Dentistry in Middletown, NY
• Providers in Middletown, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; 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.