Mark Walter Wick, DDS
Individual provider Active NPI Dentist · Savannah, MO
NPI 1861697559 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1861697559
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 012833 (MO)
- Practice address
- 803 Highway #71 West
Savannah, MO 64485-1151 - Phone
- (816) 324-5644
- Fax
- (816) 324-6307
- NPI assigned
- Jun 20, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Health Services Inc | Past | Accepting new patients | |
| Northwest Health Services Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 012833 | MO | Yes |
Addresses
Primary practice location
803 Highway #71 West
Savannah, MO 64485-1151
Mailing address
803 Highway #71 West
Savannah, MO 64485-1151
Phone (816) 324-5644
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28276 | Other | MO | BNDD |
| 1861697559 | Medicaid | MO |
Other providers in Savannah, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.