Roberta Ellen Wisun, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

3001 6TH St
Great Lakes, IL 60088-2833

Phone

(847) 688-2100

NPI assigned

Dec 23, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689651333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1251 N MAIDSTONE DR",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611087",
            "telephone_number": "847-362-4794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 6TH ST",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600882833",
            "telephone_number": "847-688-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISUN",
        "first_name": "ROBERTA",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Roy Welder, M.D.
• James Allen Westra, M.D.
• Lauren Wiles, DMD
• Rhonda Wiley, IDC
• Larry Nolan Williams Jr., DDS
• Shauna Wittke, RDH
• Walter R Wittke, DDS
• Joseph Phillip Yancho, DDS
• Joseph B. Youkhana, M.D.
• Michael Zenz, M.A.

• General Practice Dentistry in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.