Eric J Wisdom, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5188 Issued in KS

Practice address

1629 Poyntz Ave
Manhattan, KS 66502-4148

Phone

(785) 776-1771

Fax

(785) 539-3905

NPI assigned

Jul 15, 2006

Last updated

Nov 29, 2012By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Eric J. Wisdom D.D.S., P.a.

  • General Practice Dentistry
  • Manhattan, KS
  • NPI 1861418469
  Authorized official Same address or phone

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354147200000",
    "number": "1902822596",
    "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": {
        "last_name": "WISDOM",
        "first_name": "ERIC",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2012-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "5188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100095990C",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Wilson, APRN
• Nicole M Wilson, LMSW
• Teal Wilson
• Aleeyah Grace Winegarner
• Loretta A Winfrey, RN
• Robert Wisdom, LMLP, LCP
• Grant A Witcher, DDS
• Witt Eye Centers PA
• Courtney Witt, LCMFT, LMFT
• Julie Marie Witt, O.D.

• General Practice Dentistry in Manhattan, KS
• Providers in Manhattan, KS by specialty
• General Practice Dentistry in Kansas

• 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.