Cody Michael Wisnom, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

17703 Issued in MD

Practice address

650 W Baltimore St
Baltimore, MD 21201-1510

Phone

(410) 706-7101

NPI assigned

Mar 12, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Dental Associates L.L.C.

  • General Practice Dentistry
  • Westminster, MD
  • NPI 1205805801
  NPD (past)

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

{
    "created_epoch": "1647043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647043200000",
    "number": "1538817218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 W FAYETTE ST # T1501B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212016052",
            "telephone_number": "443-866-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 W BALTIMORE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212011510",
            "telephone_number": "410-706-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNOM",
        "first_name": "CODY",
        "middle_name": "MICHAEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-12",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "17703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert William Wisner-Carlson, M.D.
• Amanda Catherine Wisniewski, LMSW
• Carolyn R Wisniewski, C.R.N.P.
• Emily Wisniewski, M.D.
• Julia A. Wisniewski, M.D.
• Stephen John Witanowski, MD
• Kristina Grace Witcher, MD
• With Grace Supportive Living
• With Love Assisted Living and Adult Care Limited Liability Company
• Aniya Witherspoon

• Dentist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Dentist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2022; 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.