NPIMap

Organization Active NPI

Wisconsin Dental Group, S.C.

  • Pediatric Dentistry
  • Milwaukee, WI
National Provider Identifier
1043340417
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
WISCONSIN DENTAL GROUP, S.C.
Practice address
1575 N Rivercenter Dr Ste 200
Milwaukee, WI 53212-3965
Phone
(414) 276-5453
Fax
(414) 276-1715
NPI assigned
Mar 6, 2007
Organization subpart
Yes
Parent organization
WISCONSIN DENTAL GROUP, S.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1575 N Rivercenter Dr Ste 200
Milwaukee, WI 53212-3965

Mailing address

1575 N Rivercenter Dr Ste 200
Milwaukee, WI 53212-3965
Phone (414) 276-5453

Other names 1

  • ForwardDental RiverCenter Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Wi DTL GRP-HLS CRNS32 organizations share this tax ID, including this one
Part of
Wi DTL GRP-HLS CRNS

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

1575 N Rivercenter Dr
Ste 200
Milwaukee, WI 53212
Phone (414) 276-5453

Practitioners & affiliated clinicians

Practitioners 1

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": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1043340417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 N RIVERCENTER DR STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123965",
            "telephone_number": "414-276-5453",
            "fax_number": "414-276-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 N RIVERCENTER DR STE 200",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123965",
            "telephone_number": "414-276-5453",
            "fax_number": "414-276-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN DENTAL GROUP, S.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WISCONSIN DENTAL GROUP, S.C.",
        "enumeration_date": "2007-03-06",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ForwardDental RiverCenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; 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.