Gustavo J Wiscovitch, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

0014499 Issued in FL

Practice address

6031 Dr Martin Luther King Jr St N
St Petersburg, FL 33703-1139

Phone

(727) 521-6645

Fax

(727) 521-6648

NPI assigned

Apr 9, 2007

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

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

State licenses

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831212331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6031 DR MARTIN LUTHER KING JR ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337031139",
            "telephone_number": "727-521-6645",
            "fax_number": "727-521-6648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6031 DR MARTIN LUTHER KING JR ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337031139",
            "telephone_number": "727-521-6645",
            "fax_number": "727-521-6648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISCOVITCH",
        "first_name": "GUSTAVO",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "0014499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terri L Winters-Jones, RN
• Samantha Marie Winton, PH.D.
• Aaron Wintrich
• Cody Wipperman, OTR/L
• Karen Wisby, ARNP
• Wise Care Medical Supplies Inc
• Wise Mind Psychology Center
• Elizabeth Wise, ARNP
• Jillian Wise, PHD
• Brittany D Wisehart

• Endodontics in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Endodontics in Florida

• 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.
• 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.