NPIMap

Organization Active NPI

Karen M. Boettcher, D.D.S.,S.C.

  • General Practice Dentistry
  • Sussex, WI
National Provider Identifier
1023197910
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4623 Issued in WI
Legal business name
KAREN M. BOETTCHER, D.D.S.,S.C.
Practice address
N63 W23401 Main St
Sussex, WI 53089-0229
Phone
(262) 246-6806
Fax
(262) 246-6892
NPI assigned
Nov 3, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Karen M Boettcher, D.D.S.
Title
President
Phone
(262) 246-6806

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 4623 WI Primary

Addresses

Primary practice location

N63 W23401 Main St
Sussex, WI 53089-0229

Mailing address

P O Box 229
Sussex, WI 53089-0229
Phone (262) 246-6806

Other identifiers 2

IdentifierTypeStateIssuer
35913OtherAETNA
1455326OtherUNITED CONCORDIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023197910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 229",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530890229",
            "telephone_number": "262-246-6806",
            "fax_number": "262-246-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N63 W23401 MAIN ST",
            "city": "SUSSEX",
            "state": "WI",
            "postal_code": "530890229",
            "telephone_number": "262-246-6806",
            "fax_number": "262-246-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAREN M. BOETTCHER, D.D.S.,S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOETTCHER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-246-6806",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "4623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "35913",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1455326",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sussex, 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.