Active NPI
John S Phillips, D.D.S.
- General Practice Dentistry
- Fond Du Lac, WI
National Provider Identifier
1003839762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 01830
- Practice address
- 535 E Division St
Fond Du Lac, WI 54935-3735 - Phone
- (920) 921-8950
- Fax
- (920) 921-0577
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 01830 | WI | Primary |
Addresses
Primary practice location
535 E Division St
Fond Du Lac, WI 54935-3735
Mailing address
535 E Division St
Fond Du Lac, WI 54935-3735
Phone (920) 921-8950
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 391790260015 | Other | WI | BLUE CROSS/BLUE SHIELD ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01830 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003839762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 E DIVISION ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353735",
"telephone_number": "920-921-8950",
"fax_number": "920-921-0577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 E DIVISION ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353735",
"telephone_number": "920-921-8950",
"fax_number": "920-921-0577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "JOHN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "01830",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD ID",
"identifier": "391790260015",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.