NPIMap

Organization Active NPI

Octavia Simkins-Wiseman DDS PC

Doing business as Mitchellville Family Dentistry

  • Dentist
  • Glenn Dale, MD
National Provider Identifier
1548536949
Registry record updated Mar 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
10983 Issued in MD
Legal business name
OCTAVIA SIMKINS-WISEMAN DDS PC
Doing business as
Mitchellville Family Dentistry
Practice address
12150 Annapolis Road
Suite 301
Glenn Dale, MD 20769
Phone
(301) 249-8000
Fax
(301) 249-4958
NPI assigned
Mar 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2013

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

Authorized official

Name
Dr. Octavia Simkins-Wiseman, DDSNPI 1164648010
Title
Ceo
Phone
(240) 393-9861

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 10983 MD Primary

Addresses

Primary practice location

12150 Annapolis Road
Suite 301
Glenn Dale, MD 20769

Mailing address

12150 Annapolis Road
Suite 301
Glenn Dale, MD 20769
Phone (301) 249-2862

Other names 1

  • Mitchellville Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363564800000",
    "number": "1548536949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS ROAD",
            "address_2": "SUITE 301",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "20769",
            "telephone_number": "301-249-2862",
            "fax_number": "301-249-4958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS ROAD",
            "address_2": "SUITE 301",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "20769",
            "telephone_number": "301-249-8000",
            "fax_number": "301-249-4958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCTAVIA SIMKINS-WISEMAN DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-29",
        "last_updated": "2013-03-18",
        "status": "A",
        "authorized_official_last_name": "SIMKINS-WISEMAN",
        "authorized_official_first_name": "OCTAVIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "240-393-9861",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MD",
            "license": "10983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mitchellville Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenn Dale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; 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.