Lakeshore Community Dental Clinic

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

LAKESHORE COMMUNITY DENTAL CLINIC

Practice address

1290 North Ave
Lakeshore Community Dental Clinic
Cleveland, WI 53015-1412

Phone

(920) 693-1386

NPI assigned

May 19, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Barbara J Dodge, PH.D., R.N.

Title

Dean, Health and Human Services

Phone

(920) 693-1386

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeshore Technical College Other name

Locations

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1023275013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 NORTH AVE",
            "address_2": "LAKESHORE COMMUNITY DENTAL CLINIC",
            "city": "CLEVELAND",
            "state": "WI",
            "postal_code": "530151412",
            "telephone_number": "920-693-1386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 NORTH AVE",
            "address_2": "LAKESHORE COMMUNITY DENTAL CLINIC",
            "city": "CLEVELAND",
            "state": "WI",
            "postal_code": "530151412",
            "telephone_number": "920-693-1386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE COMMUNITY DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-19",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "DODGE",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DEAN, HEALTH AND HUMAN SERVICES",
        "authorized_official_telephone_number": "920-693-1386",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PH.D., R.N."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38394700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Technical College",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Agnes E Deehr, LPN
• Michelle Ann Hemb
• Carol Ilma Jacobs, NP
• Gary J Kunz, MSN
• Latreace Hope Laack, MSW, APSW
• Tao Lee, NP
• Stephanie Lemkuil, OTR/L
• Amy Sue McKenzie, MSW LCSW SAC
• Milwaukee Vamc
• Doris Misiak, LMSW

• Dental Clinic/Center in Cleveland, WI
• Providers in Cleveland, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 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.