Dr. Gustavo J Wiscovitch, DMD
Dentist, Endodontics in St Petersburg, FL. Individual provider (NPI-1).
NPI number1831212331
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1831212331
- Entity type
- Individual (NPI-1)
- Name
- Dr. Gustavo J Wiscovitch
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 9, 2007
- Last updated
- Jul 8, 2007
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - OTHER (PHYSICIAN)
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223E0200X | Dentist, Endodontics | 0014499 | FL | Yes |
Practice location
6031 Dr Martin Luther King Jr St NSt Petersburg, FL 33703-1139
Phone 727-521-6645 · Fax 727-521-6648
Mailing address
6031 Dr Martin Luther King Jr St NSt Petersburg, FL 33703-1139
Phone 727-521-6645 · Fax 727-521-6648
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