Provider Demographics
NPI:1780868455
Name:WIMER, CHAD J (DDS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:J
Last Name:WIMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS605311223G0001X
MO20090136431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice