Kevin Christopher Wiman, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN27643 Issued in FL

Practice address

8823 Goodbys Executive Dr
Jacksonville, FL 32217-4605

Phone

(470) 336-2612

NPI assigned

Jul 8, 2014

Sex

Male

Sole proprietor

Yes

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Patriot Family Dental PA

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1982571584
  NPD Authorized official
• Joseph R. Boulter, D.M.D., M.a.G.D., P.a.

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1225232176
  NPD (past)

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

{
    "created_epoch": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772755200000",
    "number": "1811303183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 GOODBYS EXECUTIVE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174605",
            "telephone_number": "904-731-0432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8823 GOODBYS EXECUTIVE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174605",
            "telephone_number": "470-336-2612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMAN",
        "first_name": "KEVIN",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-08",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN27643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy E Wilson, LCSW
• Taneisha Evette Wilson
• Teri Wilson
• Richard Jacob Wiltse, M.D.
• Precious Symone Wiltshire, LMT
• Todd Wimberley, APRN
• Anisha Wimbish
• Wims Executive Holdings
• Alacia Brittania Wims
• Chamara Wims, NP

• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; 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.

Verify at the official NPI Registry.