NPIMap

Organization Active NPI

East Grove Dental SC

  • General Practice Dentistry
  • Madison, WI
National Provider Identifier
1023073178
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5133 Issued in WI
Legal business name
EAST GROVE DENTAL SC
Practice address
826 Atlas Ave
Madison, WI 53714-3114
Phone
(608) 222-8344
Fax
(608) 222-8376
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Sandra L Lysloff
Title
Office Administrator
Phone
(608) 222-8344

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 1727G WI
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 2808 WI
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5133 WI Primary

Addresses

Primary practice location

826 Atlas Ave
Madison, WI 53714-3114

Mailing address

826 Atlas Ave
Madison, WI 53714-3114
Phone (608) 222-8344

National Provider Directory

National Provider Directory

Locations

826 Atlas Ave
Madison, WI 53714
Phone (608) 222-8344

Practitioners & affiliated clinicians

Practitioners 3

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": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023073178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 ATLAS AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537143114",
            "telephone_number": "608-222-8344",
            "fax_number": "608-222-8376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 ATLAS AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537143114",
            "telephone_number": "608-222-8344",
            "fax_number": "608-222-8376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GROVE DENTAL SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LYSLOFF",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "608-222-8344",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1727G",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "2808",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.