Pro Dental Wi 1 PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PRO DENTAL WI 1 PC

Practice address

1838 S 15TH St
Milwaukee, WI 53204-3225

Phone

(414) 455-8805

Fax

(414) 455-8812

NPI assigned

Sep 18, 2024

Organization subpart

No

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

Authorized official

Name

Mrs. Simone Wilson-Adeleke, MPA-PPA

Title

Director of Credentialing

Phone

(732) 731-8398

Specialties & licenses 2

Addresses

Other names 1

• Destiny Dental of Milwaukee Doing business as

Locations

Practitioners 2

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

• Richard Yongyup Kim, DDS

  • Dentist
  • Milwaukee, WI
  • NPI 1740403559
  NPD
• Wei Wang, DDS

  • General Practice Dentistry
  • Onalaska, WI
  • NPI 1548157951

  General Practice

  NPD

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

{
    "created_epoch": "1726617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1013744523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WOODBRIDGE CENTER DR STE 520",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070951152",
            "telephone_number": "732-731-8398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1838 S 15TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532043225",
            "telephone_number": "414-455-8805",
            "fax_number": "414-455-8812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO DENTAL WI 1 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-18",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "WILSON-ADELEKE",
        "authorized_official_first_name": "SIMONE",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "732-731-8398",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPA-PPA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Destiny Dental of Milwaukee",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lucy Pritzlaff, RN
• Private Clinic.
• Private Healthcare Facilities
• Private Nurse
• Colleen Mary Prividera, LMFT-IT, APSW
• Pro Step Physical Therapy LLC
• Pro-Family Home Care LLC
• Procare Medical Group SC
• Procare Urgent Care LLC
• Elizabeth Procknow Gabriel, PA

• Dentist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.