Individual provider Active NPI

Susan Marie Skrzypczak, CDA, RDH

  • Dental Hygienist
  • Waukesha, WI
National Provider Identifier
1023666161
Registry record updated Sep 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental HygienistTaxonomy code 124Q00000X
License
4524-16 Issued in WI
Practice address
711 W Moreland Blvd
Waukesha, WI 53188-2483
Phone
(920) 251-6630
NPI assigned
Sep 2, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 4524-16 WI Primary

Addresses

Primary practice location

711 W Moreland Blvd
Waukesha, WI 53188-2483

Mailing address

317 Lopas St
Menasha, WI 54952-3420
Phone (920) 251-6630

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address toothtime@bbsmiles.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4524-16WIMDDental Hygienist

NPI Registry JSON

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

{
    "created_epoch": "1567382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567382400000",
    "number": "1023666161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 LOPAS ST",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549523420",
            "telephone_number": "920-251-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W MORELAND BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882483",
            "telephone_number": "920-251-6630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKRZYPCZAK",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "CDA, RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-02",
        "last_updated": "2019-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "WI",
            "license": "4524-16",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "toothtime@bbsmiles.org",
            "affiliation": "N",
            "endpointDescription": "Bridging Brighter Smiles",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "711 W Moreland Blvd",
            "city": "Waukesha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531882483",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2019; 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.