Jay Wickersham

Dentist · Riverview, FL

Individual Active NPI

NPI number 1285251389

Practice location

12926 Us Highway 301 S Ste 5
Riverview, FL 33578-7458
Phone
(217) 540-5100

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NPI record

NPI
1285251389
Entity type
Individual (Type 1)
Enumeration date
July 6, 2020
Last updated
July 6, 2020
Certified
July 6, 2020
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Dentist Primary 122300000X DN25056 FL

About Jay Wickersham

Jay Wickersham is a healthcare provider registered in the NPI registry with the primary taxonomy Dentist (code 122300000X). The practice location is 12926 Us Highway 301 S Ste 5, Riverview, FL 33578-7458. The NPI number 1285251389 was assigned on July 6, 2020 and the record was last updated on July 6, 2020.

Jay Wickersham lists a license in the registry: #DN25056 (FL) for Dentist. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Jay Wickersham?

The NPI number is 1285251389.

What is the phone number of Jay Wickersham?

The phone number listed for the practice location is (217) 540-5100.

Where is Jay Wickersham located?

12926 Us Highway 301 S Ste 5, Riverview, FL 33578-7458.

What is the taxonomy code for Jay Wickersham?

The primary taxonomy code is 122300000X – Dentist.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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