Campbellsport Family Dentistry, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CAMPBELLSPORT FAMILY DENTISTRY, LLC

Doing business as

Campbellsport Family Dentistry

Practice address

130 N Fond Du Lac Ave
Campbellsport, WI 53010-2787

Phone

(920) 533-8512

NPI assigned

Apr 20, 2024

Last updated

Apr 20, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel Stevens, DDSNPI 1871980573

Title

Owner

Phone

(608) 957-4663

Specialties & licenses 1

Addresses

Other names 1

• Campbellsport Family Dentistry Doing business as

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Stevens, D.D.S.

  • General Practice Dentistry
  • Mayville, WI
  • NPI 1871980573
  NPD Authorized official
• Katherine Su, DDS

  • Dentist
  • Campbellsport, WI
  • NPI 1396631982
  NPD
• Ronald Moos, DDS

  • Dentist
  • Campbellsport, WI
  • NPI 1972649952
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713571200000",
    "number": "1073368254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 N FOND DU LAC AVE",
            "city": "CAMPBELLSPORT",
            "state": "WI",
            "postal_code": "530102787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 N FOND DU LAC AVE",
            "city": "CAMPBELLSPORT",
            "state": "WI",
            "postal_code": "530102787",
            "telephone_number": "920-533-8512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELLSPORT FAMILY DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-20",
        "last_updated": "2024-04-20",
        "certification_date": "2024-04-20",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-957-4663",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campbellsport Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Agnesian Healthcare Inc (SSM Health Fond Du Lac Regional Clinic)
• Ashley Zimdahl
• Aurora Pharmacy, Inc. (Aurora Pharmacy)
• Campbellsport School District
• Consultants Laboratory of Wisconsin, LLC
• David a. Krebs (Krebs Chiropractic Office)
• Kathleen Diane Depies, R.N.
• Michelle A Dunn

• Dental Clinic/Center in Campbellsport, WI
• Providers in Campbellsport, WI by specialty
• Dental Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2024; 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.