Brad Wisowaty DDS LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BRAD WISOWATY DDS LLC

Doing business as

Modern Dentistry

Practice address

1302 Vale Park Rd
Valparaiso, IN 46383-2722

Phone

(219) 462-0780

NPI assigned

May 3, 2023

Last updated

May 3, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brad Wisowaty, DDS

Title

Member

Phone

(708) 945-5405

Specialties & licenses 1

Addresses

Other names 1

• Modern Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bradley Wisowaty

  • Dentist
  • Valparaiso, IN
  • NPI 1306229562
  NPD
• John L. Havlick, D.D.S.

  • General Practice Dentistry
  • Valparaiso, IN
  • NPI 1306864442
  NPD (past)

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

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1609565910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 VALE PARK RD",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 VALE PARK RD",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463832722",
            "telephone_number": "219-462-0780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "809 Wall St Ste A",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "463832571",
            "country_code": "US",
            "telephone_number": "219-464-9681",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRAD WISOWATY DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-03",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "WISOWATY",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "708-945-5405",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marsha Bosseau, RN
• McKenzi Elizabeth Bowen
• Linda Nowzaradan Boxum, D.O.
• Michael Scott Boxum, D.O.
• Monique Boyd
• Jane Bradlaw, D.O.
• Tareq Braik, M.D.
• Jennifer L Braspenning, OTR
• Laura Mae Braun, LMHCA
• Scott James Braun, D.C.

• Dental Clinic/Center in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Dental Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.