DR. DAVID PATRICK WICKNESS (NPI# 1235202953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235202953 |
| Entity Type | Individual |
| Full Name | DR. DAVID PATRICK WICKNESS |
| Credential | D.M.D. |
| Practice Address |
1701 S Prospect Ave Suite 203 Champaign IL 61820-7050 |
| Practice Telephone | 2173595050 |
| Mailing Telephone | 2173595050 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
IL | Dental Providers |
| Street Address |
1701 S PROSPECT AVE SUITE 203 |
| City | CHAMPAIGN |
| State | IL |
| Zip Code | 61820-7050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326039140 | James William Hannum | Psychologist | 1701 S Prospect Ave, Suite 205, Champaign, IL 61820-7050 | 2005-11-01 |
| 1992007231 | Jim Hamilton Counseling and Therapy Company | Counselor | 1701 S Prospect Ave, Suite 101, Champaign, IL 61820-7050 | 2010-11-18 |
| 1922308949 | James Lowell Hamilton Jr. | Counselor | 1701 S Prospect Ave, Suite 101, Champaign, IL 61820-7050 | 2010-10-25 |
| 1205162302 | Julieann Krogel | Psychologist | 1701 S Prospect Ave, Suite 306, Champaign, IL 61820-7050 | 2009-10-23 |
| 1427262435 | Judy Kay Osgood | Psychologist | 1701 S Prospect Ave, Suite 302, Champaign, IL 61820-7050 | 2007-05-09 |
| 1851416770 | Graciela V. Andresen | Psychologist | 1701 S Prospect Ave, Suite 202, Champaign, IL 61820-7050 | 2007-03-20 |
| 1093825101 | Jean A Benacker | Psychologist | 1701 S Prospect Ave, Suite 205, Champaign, IL 61820-7050 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1255963583 | Jamey Richard Bailey | Social Worker | 701 Devonshire Drive, Bldg C, Suite 206, C-6, Champaign, IL 61820 | 2020-02-05 |
| 1790247443 | Jason Abrams | Counselor | 201 W Springfield Ave., Suite 1002-1003, Champaign, IL 61820 | 2019-04-02 |
| 1184100273 | Janine Rafferty | Pharmacist | 2002 N Neil St, Champaign, IL 61820 | 2018-07-12 |
| 1417475070 | Brodbeck Counseling, PC | Community/Behavioral Health | 301 N. Neil Street Suite 323, Champaign, IL 61820 | 2017-09-05 |
| 1447773726 | Quanata M Pelmore | Nurse's Aide | 508 E. Vine St, Champaign, IL 61820 | 2017-07-19 |
| 1821518127 | Molly Mclay | Social Worker | 309 W Clark St., Champaign, IL 61820 | 2017-06-27 |
| 1396265849 | Lou Echols Chambers | Audiologist | 901 South Sixth Street, Chamapign, IL 61820 | 2017-06-26 |
| 1962874495 | Luciana Angelica Guardini | Social Worker | 100 North Chestnut Street, Suite 244, Champaign, IL 61820 | 2015-10-23 |
| 1538544465 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 410 E University Ave Ste 105, Champaign, IL 61820 | 2015-07-21 |
| Find all providers in zip 61820 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295268019 | Mountain Bay Dental LLC | Dentist | 3510 Marianna Dr, Champaign, IL 61822-9502 | 2017-04-08 |
| 1982094462 | Familia Dental Champaign LLC | Dentist | 1907 W Spfld Ave, Champaign, IL 61821-3067 | 2015-02-04 |
| 1205245693 | Illini Smiles Dental Care PC | Dentist | 201 W Springfield Ave Ste 506, Champaign, IL 61820-6383 | 2014-08-11 |
| 1306152806 | Tania G Lodhi | Dentist | 1902 N Prospect Ave, Suite 1, Champaign, IL 61822-1411 | 2010-08-23 |
| 1154651628 | Michael R Ruffatto | Dentist | 1202 Harrington Dr, Champaign, IL 61821-6514 | 2010-01-06 |
| 1407005879 | Promise Healthcare Nfp | Dentist | 819 Bloomington Road, Champaign, IL 61820 | 2008-09-10 |
| 1851540330 | Central Illinois Oral and Maxiofacial Surgery, PC | Dentist | 14 E Anthony Dr Ste C, Champaign, IL 61820-2749 | 2008-09-09 |
| 1407002165 | Nikkole Patterson | Dentist | 3101 Village Office Pl, Champaign, IL 61822-7673 | 2008-08-13 |
| 1407010176 | Douglas M Wallen | Dentist | 2502 Galen Dr, Suite 103, Champaign, IL 61821-7045 | 2008-07-11 |
| 1275703175 | Thomas E. Standley, Dmd, PC | Dentist | 30 E Green St, Suite 1, Champaign, IL 61820-7905 | 2008-03-06 |
| Find all providers in CHAMPAIGN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.