NPIMap

Organization Active NPI

First City Dental of Abbotsford, SC

  • Dentist
  • Abbotsford, WI
National Provider Identifier
1053432955
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
WI4940 Issued in WI
Legal business name
FIRST CITY DENTAL OF ABBOTSFORD, SC
Practice address
202 Birch St
Abbotsford, WI 54405-9439
Phone
(715) 223-4844
Fax
(715) 223-6957
NPI assigned
Apr 2, 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
Dr. Troy D Rens, DDSNPI 1346295144
Title
Owner
Phone
(715) 223-4844

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X WI4941 WI
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X WI4940 WI Primary

Addresses

Primary practice location

202 Birch St
Abbotsford, WI 54405-9439

Mailing address

PO Box 147
Abbotsford, WI 54405-0147
Phone (715) 223-4844

Other identifiers 2

IdentifierTypeStateIssuer
33742800MedicaidWI
33742700MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053432955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 147",
            "city": "ABBOTSFORD",
            "state": "WI",
            "postal_code": "544050147",
            "telephone_number": "715-223-4844",
            "fax_number": "715-223-6957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 BIRCH ST",
            "city": "ABBOTSFORD",
            "state": "WI",
            "postal_code": "544059439",
            "telephone_number": "715-223-4844",
            "fax_number": "715-223-6957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST CITY DENTAL OF ABBOTSFORD, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RENS",
        "authorized_official_first_name": "TROY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-223-4844",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "WI4941",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "WI4940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33742800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33742700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Abbotsford, 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.