Mark Walter Wick, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

012833 Issued in MO

Practice address

803 Highway #71 West
Savannah, MO 64485-1151

Phone

(816) 324-5644

Fax

(816) 324-6307

NPI assigned

Jun 20, 2007

Last updated

Mar 7, 2023By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwest Health Services Inc

  dba Savannah Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Savannah, MO
  • NPI 1104947126
  NPD (past)
• Northwest Health Services Inc

  dba Downtown Health Center

  • Federally Qualified Health Center (FQHC)
  • Saint Joseph, MO
  • NPI 1538059118
  NPD (past)

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1861697559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 HIGHWAY #71 WEST",
            "city": "SAVANNAH",
            "state": "MO",
            "postal_code": "644851151",
            "telephone_number": "816-324-5644",
            "fax_number": "816-324-6307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 HIGHWAY #71 WEST",
            "city": "SAVANNAH",
            "state": "MO",
            "postal_code": "644851151",
            "telephone_number": "816-324-5644",
            "fax_number": "816-324-6307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICK",
        "first_name": "MARK",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-20",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "012833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Progressive Health Care Group, Inc. (Shady Lawn RCF)
• The Progressive Health Care Group, Inc. (Shady Lawn Nursing Home)
• TMH Associates LLC (Savannah Family Pharmacy)
• TMH Associates LLC (Savannah Family Pharmacy)
• Toshanda Farms LLC
• Brandon Yokota, DDS

• Dentist in Savannah, MO
• Providers in Savannah, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.