NPIMap

Organization Active NPI

Wise Dentistry for Kids, PSC

  • Pediatric Dentistry
  • Campbellsville, KY
National Provider Identifier
1790075166
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
8254 Issued in KY
Legal business name
WISE DENTISTRY FOR KIDS, PSC
Practice address
105 Medical Park Dr
Suite 1
Campbellsville, KY 42718-9622
Phone
(270) 469-1403
Fax
(270) 469-1405
NPI assigned
Apr 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Heather Wise, DMD
Title
Owner/Dentist
Phone
(270) 469-1403

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 8254 KY Primary

Addresses

Primary practice location

105 Medical Park Dr
Suite 1
Campbellsville, KY 42718-9622

Mailing address

105 Medical Park Drive
Suite 1
Campbellsville, KY 42718
Phone (270) 469-1403

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1790075166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MEDICAL PARK DRIVE",
            "address_2": "SUITE 1",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "42718",
            "telephone_number": "270-469-1403",
            "fax_number": "270-469-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MEDICAL PARK DR",
            "address_2": "SUITE 1",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427189622",
            "telephone_number": "270-469-1403",
            "fax_number": "270-469-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE DENTISTRY FOR KIDS, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-19",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "270-469-1403",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KY",
            "license": "8254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbellsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.

Verify at the official NPI Registry.