Jeffrey L Wasielewski, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2901017635 Issued in MI

Practice address

9416 S Main St
Ste 211
Plymouth, MI 48170-4157

Phone

(734) 455-0710

Fax

(734) 455-4433

NPI assigned

Jul 27, 2006

Last updated

Jul 23, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

State licenses

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1639193915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9416 S MAIN ST STE 211",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704183",
            "telephone_number": "734-478-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9416 S MAIN ST",
            "address_2": "STE 211",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704157",
            "telephone_number": "734-455-0710",
            "fax_number": "734-455-4433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASIELEWSKI",
        "first_name": "JEFFREY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MI",
            "license": "2901017635",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MI",
            "license": "2901017635",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Warren
• Shawn D Warren
• Jacqueline Washington
• Raymond Washington
• Tamia Jamelia Washington
• Jodi Marie Wasik, OTR/L
• Nicole Marie Wassel, LMSW
• Lauren Marie Waters, LMSW-C
• Clare Waterstradt
• Alexis Marie Watson

• Oral and Maxillofacial Surgery (Dentist) in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; 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.