Robin A Wetherell, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

805 N 1St St
Vienna, IL 62995-1544

Phone

(618) 658-8361

Fax

(618) 658-8039

NPI assigned

Dec 8, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912066390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N 1ST ST",
            "address_2": "P.O. BOX 397",
            "city": "VIENNA",
            "state": "IL",
            "postal_code": "629951544",
            "telephone_number": "618-658-8361",
            "fax_number": "618-658-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 N 1ST ST",
            "city": "VIENNA",
            "state": "IL",
            "postal_code": "629951544",
            "telephone_number": "618-658-8361",
            "fax_number": "618-658-8039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETHERELL",
        "first_name": "ROBIN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vienna Public School District #55 (Vienna Grade School)
• Rachael Visser, BA MHP
• Riley Warren, BA, MHP
• Jamie L Weinberg, MS QMHP
• Janet Lea Weston, RN, BS, MHP
• Patti A Williamson, MSW QMHP
• Rebecca Winterrowd
• Dylan Winters, BA MHP
• Jodi Witthaus, MSW QMHP
• Rechelle Worthan, BSW MHP

• General Practice Dentistry in Vienna, IL
• Providers in Vienna, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.