Thomas R Wiedemann, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13165 Issued in MO

Practice address

3707 Watson Rd
Saint Louis, MO 63109-1236

Phone

(314) 645-6400

NPI assigned

Jun 28, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Thomas R. Wiedemann, DDS,PC

  • Dental Clinic/Center
  • Saint Louis, MO
  • NPI 1245390798
  NPD (past) Authorized official
• Dr. Stephen Eugene Christy D.M.D.

  • Dentist
  • Saint Louis, MO
  • NPI 1801257274
  NPD (past)

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790782399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 WATSON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631091236",
            "telephone_number": "314-645-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3707 WATSON RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631091236",
            "telephone_number": "314-645-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEMANN",
        "first_name": "THOMAS",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "13165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "13165",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judy Wider-Jones, RN
• Devin Eugene Widick, DDS
• Konrad Widmer
• Gregory Widner, MSW
• Heidi L Wiechert
• Richard H Wieder, MD
• Ashley Wiegand, PHD, LMFT
• Emily Wiegers
• Clara E Wiegman, PSYD
• Neeley Wiehadt

• General Practice Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.