Northern Door Dental SC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5002020015 Issued in WI

Legal business name

NORTHERN DOOR DENTAL SC

Practice address

10589 S Highland Rd Ste 4
Sister Bay, WI 54234

Phone

(920) 854-5200

Fax

(920) 854-7601

NPI assigned

Apr 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Malcolm Mayhew III, DDS

Title

Dentist Practice President Owner

Phone

(920) 854-5200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel B Anderson, DDS

  • General Practice Dentistry
  • Sister Bay, WI
  • NPI 1821296146
  NPD (past)
• C Thomas Wilson, DDS

  • General Practice Dentistry
  • Sister Bay, WI
  • NPI 1841404969
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1013038207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10589 S HIGHLAND RD STE 4",
            "city": "SISTER BAY",
            "state": "WI",
            "postal_code": "54234",
            "telephone_number": "920-854-5200",
            "fax_number": "920-854-7601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10589 S HIGHLAND RD STE 4",
            "city": "SISTER BAY",
            "state": "WI",
            "postal_code": "54234",
            "telephone_number": "920-854-5200",
            "fax_number": "920-854-7601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN DOOR DENTAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "MAYHEW",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MALCOLM",
        "authorized_official_title_or_position": "DENTIST PRACTICE PRESIDENT OWNER",
        "authorized_official_telephone_number": "920-854-5200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5002020015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33368800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dawn E Lewen, PTA
• John Ernest Ludwigsen, DDS
• Paige Martin, LPTA
• Robert Edwin Morley, DC
• Northern Door Chiropractic and Wellness LLC (Northern Door Chiropractic and Wellness)
• Northern Door Physical Therapy & Wellness LLC
• Anna Olson, DPT
• Elizabeth Ellen Patera-Butz, LPC
• Maynard Dillon Poland, M.D.
• Lori Solberg Pothast, P.T.

• General Practice Dentistry in Sister Bay, WI
• Providers in Sister Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; 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.