Active NPI
Ryan William Tietz, D.D.S.
- Dentist
- Hudson, WI
National Provider Identifier
1760471643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6128-015
- Practice address
- 744 Ryan Dr
Hudson, WI 54016-7979 - Phone
- (715) 386-5400
- NPI assigned
- Oct 13, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D11962 | MN | |
| Dentist | 122300000X | 6128-015 | WI | Primary |
Addresses
Primary practice location
744 Ryan Dr
Hudson, WI 54016-7979
Mailing address
444 Whitetail Pass
Hudson, WI 54016-7748
Phone (715) 808-0404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160516001934 | WI | Order and Referring Only - Other (Non-Physician) | 0547559411 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11962 | MN | MD | Dentist |
| 6128-015 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1252972800000",
"number": "1760471643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "444 WHITETAIL PASS",
"city": "HUDSON",
"state": "WI",
"postal_code": "540167748",
"telephone_number": "715-808-0404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "744 RYAN DR",
"city": "HUDSON",
"state": "WI",
"postal_code": "540167979",
"telephone_number": "715-386-5400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIETZ",
"first_name": "RYAN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-13",
"last_updated": "2009-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D11962",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6128-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hudson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2009; 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.