Kevin George Wieczerza, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2901022021 Issued in MI

Practice address

4075 Stone School Rd
Ann Arbor, MI 48108-9723

Phone

(734) 971-2200

Fax

(734) 971-2555

NPI assigned

Sep 1, 2016

Sex

Male

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kevin Wieczerza, DDS, PLLC

  • Dental Clinic/Center
  • Ann Arbor, MI
  • NPI 1295468411
  NPD Authorized official

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1750838397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4075 STONE SCHOOL RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089723",
            "telephone_number": "734-971-2200",
            "fax_number": "734-971-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4075 STONE SCHOOL RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089723",
            "telephone_number": "734-971-2200",
            "fax_number": "734-971-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIECZERZA",
        "first_name": "KEVIN",
        "middle_name": "GEORGE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-01",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901022021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles W Wickham, LMSW
• Larysa Tarashevska Wickman, M.D
• Tiffiny S Wicks, NP
• Elizabeth Widmer, M.S. OTR/L
• Baylee Autumn Wiechecki, MD
• Katharina Wiedemeyer, MD
• Emily Amanda Wiedmann, PA-C
• Christopher H Wieg, PA
• William Clay Wieger, LBSW, CPSS
• Clare Wieland

• Dentist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.