Christian R. Wyse, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5545 Issued in IA

Practice address

108 5TH Ave
Decorah, IA 52101-1319

Phone

(563) 382-3657

Fax

(563) 382-0739

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 9, 2007.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1881774271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 5TH AVE",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521011319",
            "telephone_number": "563-382-3657",
            "fax_number": "563-382-0739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 5TH AVE",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521011319",
            "telephone_number": "563-382-3657",
            "fax_number": "563-382-0739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSE",
        "first_name": "CHRISTIAN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "5545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID",
            "identifier": "1681033",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0066621",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Winneshiek Medical Center
• Christopher Jared Winters, MD
• Karla Jean Wolfs, MSW, LISW
• Bruce W Wulfsberg, M.D.
• Sarah J Wymer, MD
• Phillip S Yee, MD
• Emily L Young Johnson, C.N.M.
• Kelli Zeimetz-Mehmert, SLP
• Lisa A. Zittergruen, M.D.
• Kayla Mary Zoulek, HIS

• All providers in Decorah, IA
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.