James M Roadt, DDS
Individual provider Active NPI Dentist · Big Bend, WI
NPI 1073674560 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1073674560
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 3754015 (WI)
- Practice address
- W23657050 Big Bend Drive
Big Bend, WI 53103 - Phone
- (262) 662-1111
- Fax
- (262) 622-2111
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3754015 | WI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3754015 | WI | Yes |
Addresses
Primary practice location
W23657050 Big Bend Drive
Big Bend, WI 53103
Mailing address
W23657050 Big Bend Drive
Big Bend, WI 53103
Phone (262) 662-1111
Other providers in Big Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.