Active NPI
Christopher Fredolin Wick, DDS
- Dentist
- Kansas City, MO
National Provider Identifier
1760469266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2004015365
- Practice address
- 4910A NE 81St St
Kansas City, MO 64119-8400 - Phone
- (816) 420-9070
- Fax
- (816) 420-9052
- NPI assigned
- Dec 27, 2005
- 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 | 2004015365 | MO | Primary |
Addresses
Primary practice location
4910A NE 81St St
Kansas City, MO 64119-8400
Mailing address
19323 W 63Rd Terrace
Shawnee, KS 66218
Phone (913) 269-5142
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 407174200 | Medicaid | MO |
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 |
|---|---|---|---|
| 2004015365 | MO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135641600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320105600000",
"number": "1760469266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19323 W 63RD TERRACE",
"city": "SHAWNEE",
"state": "KS",
"postal_code": "66218",
"telephone_number": "913-269-5142",
"fax_number": "816-420-9052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4910A NE 81ST ST",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641198400",
"telephone_number": "816-420-9070",
"fax_number": "816-420-9052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICK",
"first_name": "CHRISTOPHER",
"middle_name": "FREDOLIN",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-27",
"last_updated": "2011-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MO",
"license": "2004015365",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "407174200",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.