Wilkie J Stadeker, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

011447 Issued in GA

Practice address

123 Marble Mill Rd NW
Suite B
Marietta, GA 30060-7954

Phone

(678) 354-5119

Fax

(678) 354-5191

NPI assigned

May 3, 2007

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 GA

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

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952523623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 MARBLE MILL RD NW",
            "address_2": "SUITE B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607954",
            "telephone_number": "678-354-5119",
            "fax_number": "678-354-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 MARBLE MILL RD NW",
            "address_2": "SUITE B",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607954",
            "telephone_number": "678-354-5119",
            "fax_number": "678-354-5191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STADEKER",
        "first_name": "WILKIE",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "011447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Marietta, GA
• Providers in Marietta, GA by specialty
• Periodontics in Georgia

• 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.