Constance Annie Wallander, D.M.D.
Individual provider Active NPI Dentist · Kiel, WI
NPI 1063722643 · NPPES record last updated May 5, 2023
Key facts
- NPI
- 1063722643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6626-15 (WI)
- Practice address
- 1250 Teckla PL
Kiel, WI 53042-9623 - Phone
- (920) 894-2305
- Fax
- (920) 894-3048
- NPI assigned
- Oct 15, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160405001482 | WI | Order and Referring Only - Oral Surgery |
2466759543 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| New Holstein Family Dental | Current |
Accepting new patients | |
| Between the Lakes Sleep and Airway Center LLC | Current |
Accepting new patients | |
| Kiel Family Dental LLC | Past |
Accepting new patients |
Locations
1250 Teckla Pl
Kiel, WI 53042
Phone (920) 894-2305
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6626-15 | WI | Yes |
Addresses
Primary practice location
1250 Teckla PL
Kiel, WI 53042-9623
Mailing address
1250 Teckla PL
Kiel, WI 53042-9623
Phone (920) 894-2305
Other providers in Kiel, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.