NPIMap

Organization Active NPI

Cedar Creek Dental

  • General Practice Dentistry
  • Menomonie, WI
National Provider Identifier
1043352495
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
CEDAR CREEK DENTAL
Practice address
3101 Schneider Ave SE
Suite 1
Menomonie, WI 54751-2820
Phone
(715) 233-1400
NPI assigned
Feb 13, 2007
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
Genie Kuble
Title
Contact Officer
Phone
(920) 450-0157

Specialties & licenses 1

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

Addresses

Primary practice location

3101 Schneider Ave SE
Suite 1
Menomonie, WI 54751-2820

Mailing address

3101 Schneider Ave SE
Suite 1
Menomonie, WI 54751-2820

National Provider Directory

National Provider Directory

Locations

3101 Schneider Ave SE
Ste 1
Menomonie, WI 54751
Phone (715) 233-1400

Practitioners & affiliated clinicians

Practitioners 2

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043352495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 SCHNEIDER AVE SE",
            "address_2": "SUITE 1",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "547512820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SCHNEIDER AVE SE",
            "address_2": "SUITE 1",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "547512820",
            "telephone_number": "715-233-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR CREEK DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KUBLE",
        "authorized_official_first_name": "GENIE",
        "authorized_official_title_or_position": "CONTACT OFFICER",
        "authorized_official_telephone_number": "920-450-0157"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Menomonie, 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.