Alan Joseph Wickenhauser, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-024793 Issued in IL

Practice address

708 E Bethalto Blvd
Bethalto, IL 62010-1871

Phone

(618) 377-0044

NPI assigned

Feb 1, 2008

Last updated

Aug 9, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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": "1201824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502236800000",
    "number": "1740468750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 E BETHALTO BLVD",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620101871",
            "telephone_number": "618-377-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 E BETHALTO BLVD",
            "city": "BETHALTO",
            "state": "IL",
            "postal_code": "620101871",
            "telephone_number": "618-377-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKENHAUSER",
        "first_name": "ALAN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-01",
        "last_updated": "2017-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-024793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Bethalto, IL
• Providers in Bethalto, 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 Aug 9, 2017; 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.