Provider Demographics
NPI:1548625312
Name:CHAD J. WIMER, D.D.S., P.C.
Entity type:Organization
Organization Name:CHAD J. WIMER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:JARED
Authorized Official - Last Name:WIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-826-8844
Mailing Address - Street 1:808 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2187
Mailing Address - Country:US
Mailing Address - Phone:660-826-8844
Mailing Address - Fax:660-826-8849
Practice Address - Street 1:808 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2187
Practice Address - Country:US
Practice Address - Phone:660-826-8844
Practice Address - Fax:660-826-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty