Active NPI
Ruth Juana Wise, DDS
- Dentist
- Yakima, WA
National Provider Identifier
1578738555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE00010469
- Practice address
- 12 S 8TH St
Yakima, WA 98901-3020 - Phone
- (509) 454-4143
- NPI assigned
- Apr 29, 2008
- Last updated
- Sep 18, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE00010469 | WA | Primary |
Addresses
Primary practice location
12 S 8TH St
Yakima, WA 98901-3020
Mailing address
PO Box 2605
Yakima, WA 98907-2605
Phone (509) 454-4143
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201019000128 | WA | Order and Referring Only - Dentist | 1153741897 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE00010469 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600387200000",
"number": "1578738555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2605",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989072605",
"telephone_number": "509-454-4143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 S 8TH ST",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989013020",
"telephone_number": "509-454-4143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "RUTH",
"middle_name": "JUANA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-29",
"last_updated": "2020-09-18",
"certification_date": "2020-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE00010469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.