NPIMap

Organization Active NPI

Davies Pediatric Dentistry

  • Pediatric Dentistry
  • Waukesha, WI
National Provider Identifier
1003908856
Registry record updated Jul 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
4907-015 Issued in WI
Legal business name
DAVIES PEDIATRIC DENTISTRY
Practice address
2117 Corporate Drive
Suite 100
Waukesha, WI 53189
Phone
(262) 547-5813
Fax
(262) 547-5835
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kirsten M. Davies, DDSNPI 1427137611
Title
Owner
Phone
(262) 547-5813

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 4907-015 WI Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 5000400-015 WI

Addresses

Primary practice location

2117 Corporate Drive
Suite 100
Waukesha, WI 53189

Mailing address

2117 Corporate Drive
Suite 100
Waukesha, WI 53189
Phone (262) 547-5813

Other identifiers 1

IdentifierTypeStateIssuer
33662900MedicaidWI

National Provider Directory

National Provider Directory

Locations

2117 Corporate Dr
Ste 100
Waukesha, WI 53189
Phone (262) 547-5813

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1003908856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 CORPORATE DRIVE",
            "address_2": "SUITE 100",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53189",
            "telephone_number": "262-547-5813",
            "fax_number": "262-547-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 CORPORATE DRIVE",
            "address_2": "SUITE 100",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "53189",
            "telephone_number": "262-547-5813",
            "fax_number": "262-547-5835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIES PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "DAVIES",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-547-5813",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "4907-015",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "5000400-015",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33662900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.