Chad W Wise, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

30-022975 Issued in OH

Practice address

99 Debartolo PL
Boardman, OH 44512-7014

Phone

(330) 758-2348

Fax

(330) 758-0481

NPI assigned

Nov 28, 2006

Last updated

Jun 24, 2009By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

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.

• David a Wyatt, DDS, LLS

  • Dentist
  • Boardman, OH
  • NPI 1811093545
  NPD (past)
• Professional Dental Alliance

  • General Practice Dentistry
  • Boardman, OH
  • NPI 1083919252
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245801600000",
    "number": "1881760148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 DEBARTOLO PL",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445127014",
            "telephone_number": "330-758-2348",
            "fax_number": "330-758-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 DEBARTOLO PL",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445127014",
            "telephone_number": "330-758-2348",
            "fax_number": "330-758-0481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "CHAD",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2009-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-022975",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "031655",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Williams
• Courtney Wilson, LISW
• Daniel Pearl Wilson, SOLE PROVIDER
• Tara D Winchester, D.O.
• Melinda S Winsen
• Wish U Well
• Kristyn Wolf, LPCC-S
• Hayley A Wolfe, PHARMD
• Ronald William Wolford, PT
• Molly Woodford

• Dentist in Boardman, OH
• Providers in Boardman, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; 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.