Eric J. Wisdom D.D.S., P.a.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ERIC J. WISDOM D.D.S., P.A.

Practice address

1629 Poyntz Ave
Manhattan, KS 66502-4148

Phone

(785) 776-1771

Fax

(785) 539-3905

NPI assigned

Jul 15, 2006

Organization subpart

No

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

Authorized official

Name

Eric J Wisdom, DDS

Title

Owner

Phone

(785) 776-1771

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1861418469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1629 POYNTZ AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665024148",
            "telephone_number": "785-776-1771",
            "fax_number": "785-539-3905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1629 POYNTZ AVE",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665024148",
            "telephone_number": "785-776-1771",
            "fax_number": "785-539-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC J. WISDOM D.D.S., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "WISDOM",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-776-1771",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100095990C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Manhattan, KS
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; 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.