Active NPI
Douglas D Podoll, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Amery, WI
National Provider Identifier
1003952607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 0003237
- Practice address
- 404 Wisconsin Ave
Amery, WI 54001 - Phone
- (715) 268-8109
- Fax
- (715) 268-4620
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 0003237 | WI | Primary |
Addresses
Primary practice location
404 Wisconsin Ave
Amery, WI 54001
Mailing address
404 Wisconsin Ave
Amery, WI 54001
Phone (715) 268-8109
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 |
|---|---|---|---|
| 0003237 | WI | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003952607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 WISCONSIN AVE",
"city": "AMERY",
"state": "WI",
"postal_code": "54001",
"telephone_number": "715-268-8109",
"fax_number": "715-268-4620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 WISCONSIN AVE",
"city": "AMERY",
"state": "WI",
"postal_code": "54001",
"telephone_number": "715-268-8109",
"fax_number": "715-268-4620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PODOLL",
"first_name": "DOUGLAS",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WI",
"license": "0003237",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amery, 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.