Stella Wisner, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

54571 Issued in CA

Practice address

1001 S Seaside Ave
San Pedro, CA 90731-7333

Phone

(310) 732-7512

Fax

(310) 732-7519

NPI assigned

Aug 20, 2007

Sex

Female

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 TX

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

Practice roles

Interoperability endpoints

• Direct secure messaging: stella.wisner.1@15989.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Isc San Pedro Blasser Clinic

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • San Pedro, CA
  • NPI 1821130113
  NPD (past)
• US Coast Guard Finance Center

  dba San Pedro Uscg Phcy

  • Military/U.S. Coast Guard Pharmacy
  • San Pedro, CA
  • NPI 1205933066
  NPD (past)

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426032000000",
    "number": "1972796324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 W COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015926",
            "telephone_number": "907-452-8251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S SEASIDE AVE",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907317333",
            "telephone_number": "310-732-7512",
            "fax_number": "310-732-7519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNER",
        "first_name": "STELLA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-20",
        "last_updated": "2015-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "54571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Williams, CADC II
• Leah Maree Willis
• Melissa E Wilson
• Scott William Wilson
• Windfall Family Therapy Prof Corp (Windfall Family Therapy)
• Kathi Wolfrum, D.C.
• Zoe Quinn Wolk, RDH
• Kimberly Womack, LMHC
• Shameca Womack
• Won Sur Park DDS, Inc. (A Plus Dental)

• Dentist in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; 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.