Rashidah Tynetta Wiley, D.D.S.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

64355 Issued in CA

Practice address

2400 Maritime Dr
Elk Grove, CA 95758-3660

Phone

(916) 686-8914

NPI assigned

Apr 10, 2012

Sex

Female

Sole proprietor

No

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

Enrolled in CA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Lucent Pathology Partners, Inc

  • Anatomic Pathology & Clinical Pathology Physician
  • Carmichael, CA
  • NPI 1124098736
  Medicare reassignment NPD
• Northstate Dental

  • General Practice Dentistry
  • Elk Grove, CA
  • NPI 1619758091
  NPD
• Northstate Dental University Program

  • General Practice Dentistry
  • Elk Grove, CA
  • NPI 1588498133
  NPD

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

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1578829974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9700 W TARON DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957578145",
            "telephone_number": "916-378-1007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MARITIME DR",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957583660",
            "telephone_number": "916-686-8914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "716 Stevens Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "04103",
            "country_code": "US",
            "telephone_number": "207-221-4876",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "716 Stevens Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "04103",
            "country_code": "US",
            "telephone_number": "207-221-4876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILEY",
        "first_name": "RASHIDAH",
        "middle_name": "TYNETTA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-10",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "ME",
            "license": "DEN4597",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "KY",
            "license": "10225",
            "primary": false
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "CA",
            "license": "64355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry 'Josh' W. White
• Whitelock Dental Group, Inc.
• Keyara Whiteside
• Heather Marie Wiechert, CCC-SLP
• Michael Wiederstein, PH.D.
• Malica Kilauna Wilkins
• Crystal Wilkinson, PHARMD
• Amber Michele Williams
• Andrea Victoria Williams, PSY.D., L.E.P.
• Andrew Otis Williams, D.C.

• Oral and Maxillofacial Pathology Dentistry in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Oral and Maxillofacial Pathology Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.

Verify at the official NPI Registry.