Active NPI
Kenneth Donald Neidhart, D.D.S.
- Periodontics
- Madison, WI
National Provider Identifier
1053400945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 5001291-015
- Practice address
- 2705 Marshall CT
Madison, WI 53705-2255 - Phone
- (608) 233-9167
- Fax
- (608) 233-9342
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 5001291-015 | WI | Primary |
Addresses
Primary practice location
2705 Marshall CT
Madison, WI 53705-2255
Mailing address
2705 Marshall Court
Madison, WI 53705
Phone (608) 592-2088
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5001291-015 | WI | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1053400945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2705 MARSHALL COURT",
"city": "MADISON",
"state": "WI",
"postal_code": "53705",
"telephone_number": "608-592-2088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2705 MARSHALL CT",
"city": "MADISON",
"state": "WI",
"postal_code": "537052255",
"telephone_number": "608-233-9167",
"fax_number": "608-233-9342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEIDHART",
"first_name": "KENNETH",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WI",
"license": "5001291-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.