Brian A. Wiedemer, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901019234 Issued in MI

Practice address

86-260 Farrington Hwy
Waianae, HI 96792-3128

Phone

(808) 697-3496

NPI assigned

Aug 18, 2006

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

Other identifiers 2

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273881600000",
    "number": "1730293549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86-260 FARRINGTON HWY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923128",
            "telephone_number": "808-697-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86-260 FARRINGTON HWY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923128",
            "telephone_number": "808-697-3496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEMER",
        "first_name": "BRIAN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2010-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901019234",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "CSDT-38",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "19234-MI",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4823188",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maryellen P Werner
• Amanda Reneee West
• Kathleen N. Westbrook
• Malia E White, LMHC, CSAC
• Rachel C White, RD
• Ronald Sinclair Wilhoit
• Ashley Nicole Williams, APRN
• Jennifer Williams, APRN
• Sumalee Wilson, M.S.,CCC-SLP
• Glen Wong, CSAC

• General Practice Dentistry in Waianae, HI
• Providers in Waianae, HI by specialty
• General Practice Dentistry in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2010; 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.