Active NPI
Robert Wake III, DMD
- Dentist
- Apo, NY
National Provider Identifier
1689906331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN-10049
- Practice address
- 18TH Medical Group
Unit 5142
Apo, NY 96368-0100 - Phone
- (315) 630-4395
- NPI assigned
- Feb 5, 2010
- Sex
- Male
- 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 | DEN-10049 | CO | Primary |
Addresses
Primary practice location
18TH Medical Group
Unit 5142
Apo, NY 96368-0100
Mailing address
82 Medical Group
149 Hart St
Safb, TX 76311-3482
Phone (312) 676-4744
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN-10049 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627603200000",
"number": "1689906331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "82 MEDICAL GROUP",
"address_2": "149 HART ST",
"city": "SAFB",
"state": "TX",
"postal_code": "763113482",
"telephone_number": "312-676-4744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18TH MEDICAL GROUP",
"address_2": "UNIT 5142",
"city": "APO",
"state": "NY",
"postal_code": "963680100",
"telephone_number": "315-630-4395"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKE",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-05",
"last_updated": "2021-07-30",
"certification_date": "2021-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "DEN-10049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.