NPIMap

Organization Active NPI

Wisconsin Dental Group, S.C.

  • General Practice Dentistry
  • Oconomowoc, WI
National Provider Identifier
1013665561
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Practice address
1320 Pabst Farms Cir Unit 190
Oconomowoc, WI 53066-4877
Phone
(262) 244-0288
Fax
(262) 244-0290
NPI assigned
Mar 14, 2022
Organization subpart
Yes
Parent organization
WISCONSIN DENTAL GROUP, S.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1320 Pabst Farms Cir Unit 190
Oconomowoc, WI 53066-4877

Mailing address

1320 Pabst Farms Cir Unit 190
Oconomowoc, WI 53066-4877
Phone (262) 244-0288

Other names 1

  • ForwardDental Oconomowoc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wi DTL GRP-HLS CRNS32 organizations share this tax ID, including this one
Part of
Wi DTL GRP-HLS CRNS

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

1320 Pabst Farms Cir
Unit 190
Oconomowoc, WI 53066
Phone (262) 244-0288

NPI Registry JSON

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

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1013665561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 PABST FARMS CIR UNIT 190",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664877",
            "telephone_number": "262-244-0288",
            "fax_number": "262-244-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 PABST FARMS CIR UNIT 190",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530664877",
            "telephone_number": "262-244-0288",
            "fax_number": "262-244-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN DENTAL GROUP, S.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WISCONSIN DENTAL GROUP, S.C.",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForwardDental Oconomowoc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oconomowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.